Each painful step, this health care keeps moving forward. As I've written, it is destined given the nature of this issue that every single step will be difficult as hell. Somehow, though, we keep making our way toward getting a bill done.
Harry Reid deserves the lion's share of the credit on getting this step completed. Say what you will about the messiness of the process, the ridiculous Senate rules, the deal-cutting at the end, but Harry Reid figured out how to make it work and get over one more hurdle. One of my very favorite sayings in the world, which comes from my dear friend Paul Tully (who were he alive today be involved in all this every step of the way, and loving every minute of it) is that you can't take the politics out of politics. It's especially true on a crazy quilt, complicated issue like health care.
Given the stubborn logjam between progressives and conservatives on the public option and other issues, I can see about half a dozen different scenarios for what happens next:
1. Failure. I hope and think this is very unlikely, but it is still possible, as both the conservative Senators and progressives in the House are as dug in as you can possibly be.
2. Progressives cave in and get rolled. You can see I am putting my two least favorite scenarios first. This has certainly happened quite a few times over the years, I hope it won't this time.
3. Conservative Senators agree to come along. Through some combination of persuasion, pork, concessions on a range of issues in the bill, arm-twisting, leg-breaking, and all sorts of other things, we actually get the entire Democratic caucus in the Senate to agree to the Reid compromise without giving in on the public option and other issues. This is obviously the best-case scenario as far as I am concerned.
4. Reconciliation. Reid says he doesn't plan to go this route, and nobody wants to because it is so procedurally and substantively complicated, but if all else fails this is still an option.
5. The "sweet spot". There is still the possibility of some grand compromise on the public option and other big issues that makes progressives in the House and Senate reasonably satisfied and brings over the conservative Senators. This is obviously dangerous territory seeing as how most of us progressives feel like we have already compromised virtually to the breaking point already, but Reid, Schumer, and the White House are still searching for the magic bullet. It might involve re-naming the public option, concessions in other things, policy over symbolism, a new kind of stronger trigger, or all kinds of combinations of things- some pretty bad, some not as onerous. If the deal becomes too bad, it obviously bleeds over to the 2nd scenario, but I can imagine compromises that don't cost us a lot more than has already been given (I know for a lot of you, that is already way too much, and I understand where you are coming from).
6. Just keep debating. The final scenario I can think of is for Reid to decide to just keep the debate going day after day, week after week, until he gets 60 votes. He doesn't want to do this because it would hold up every other piece of legislation, and would put some of his Democrats under an enormous amount of out-in-open political pressure. It could also backfire, as it might some of those folks dig in even more. I have a feeling, though, that this kind of dramatic tactic, which would focus enormous attention and pressure on those holdouts, would probably work even if it took a while. Even the most conservative of Democrats would not want to face the wrath of their entire party and base back home in so public a way over a long period of time, and I suspect that all of them have other legislation pending that they would want to be getting to someday.
The two biggest dangers in all of this negotiating are (1) what concessions on other issues will Reid have to make to get some reasonably strong version of the public option, and (2) are we going to get better policy or be relegated to symbolic gestures?
On the first question, the danger for progressives of having been so focused on the public option fight is that some really important other parts of the legislation get traded away. It would be a bittersweet moment indeed to get a public option, but not have adequate subsidies for poor and middle-income people, or to have middle-class health care plans taxed, or to have immigrants badly mistreated or abortion heavily restricted. We have to keep our eye on the whole bill, and not focus all of our energies just on the public option.
On the second question, it really goes back to what I wrote the other day: are we going to get decent policy, or the symbolism of good policy with all the important substance traded away. I would much rather have a real public option, for example, and call it something else to satisfy conservative Senators, than to have something being called a public option that really is not one in reality. As these negotiations go forward, progressives should focus more on the substance than on symbolic victories.
None of this is going to be easy to stomach. Why Democratic Senators can't just do the right thing is an immense frustration. But Tully was right: you can't take the politics out of politics.
One possibility would be a really strong nonprofit option run by a semi-governmental or non-governmental organization. Is there anything particularly magical about the federal government to run a health care organization?
Another possibility would be enabling and encouraging legislation for states to create a state or multistate option in their exchanges. The states can make their public options as strong as they like. My understanding is that the Canadian system is not actually a federal plan but a set of provincial plans. It might possibly include a provision making a state based public option mandatory if the top two insurers have more than 80 percent of the market share.
health care reform.
This alignment renders reform inevitable.
There is no choice for our nation on this issue.
Dr. Rick Lippin
Southampton,Pa
http://medicalcrises.blogspot.com
I am trying to formulate that question fairly, so let me try again: Is it better to try and cram down a bill and be seen as strong (but partisan and dictatorial), or to be bipartisan and allow compromise which creates legislation that pleases no one?
(I guess I can’t be fair, because I don’t believe that compromise really does create legislation that has the best ideas from both sides. Each side is too far apart and they do not even have the same goals. The Republicans want no health care reform, the Blue Dogs don’t want to spend (also resulting in no reform) and the moderates and Progressives are the only factions that want to solve the crisis in health care.)
So Howard Dean is correct, I’m afraid. This bill will please no one. But it might serve one important purpose, and that is to create a political win for Obama. He needs it and the Democrats need it to encourage them and motivate them to fight on for the rest of Obama’s objectives. But this is not a win among voters. I’d say voters admire a leader who goes for the gold—even if he fails—over a leader that settles for the bronze.
The House of Representatives removed a provision that would have allowed individual states to choose a single-payer system. To me, that's a deal-breaker.