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Robert L. Borosage

Robert L. Borosage

Posted: August 18, 2009 11:08 PM

Health Care: Let the Majority Be Heard


The editors of the Wall Street Journal say that the public option in health care reform has been "sent to the death panel." Obama "concedes" the public option, reports the Financial Times. Even liberals seem to agree. The public option is "all but gone," writes Bob Herbert of the New York Times. The American Prospect's Mark Schmitt mourns its "likely death."

Nonsense. There is no reason to exaggerate the strength of the small tong of conservative Democrats and claque of obstructionist Republicans standing in the way of reform. Here's the reality:

Offering a public plan as a choice to compete with the private insurance companies has continued strong support in polling. President Obama favors it. The Democratic leadership in both the House and the Senate support it. More importantly, a majority of legislators in the House and a broad majority of Democrats in the Senate will vote for it. Needless to say, the activist base of the party thinks it vital.

The only question is whether a small minority of Democrats in the Senate will dig themselves into such a rabid fever that they would sabotage health care reform itself to stop the public option. Whether their animus derives from ideology or insurance company contributions, it is inconceivable that a handful of Blue Dogs in the House or conservative Dems in the Senate would block the president's key reform to make their point. It would also be suicidal, for if 1994 is any indication, Democrats -- particularly those from more conservative districts -- will pay a harsh price at the polls in 2010 if they fail to pass reform.

Citizens can help concentrate their minds. Legislators have heard from the screamers in the town meetings. They've been besieged by legions of insurance company lobbyists. They've comforted seniors terrified by the lies being peddled. Now it is time for them to hear from the majority of citizens, and the vast majority of Democratic voters who want health care reform that works, one that includes both a public plan as an option to compete with the insurance companies, and the lower drug prices that will result from enabling Medicare to use its buying power to gain discounts for patients.

There are a lot of talking heads out arguing that the "left" shouldn't be so extreme as to risk health care reform by insisting on the public option or the lifting of the absurd ban on negotiating lower drug prices. The reality is exactly the reverse. It is the handful of Blue Dogs and conservative Democrats in the House and Senate that are standing in the way of the majority in favor of a comprehensive plan. The question isn't whether the progressive majority is unreasonably resisting reform to save the public option. The question is whether a small minority of conservative Democrats will sabotage reform simply to stop the public option.

Substantively, passing health care reform without a public plan to compete with the insurance companies makes no sense. As Jonathan Walker details, it would be an insurance company bonanza, as the government requires the uninsured to get health insurance - supplying the companies with millions of young and healthy customers - while eliminating the option of a competing government run plan that, in Obama's words, can "keep the insurance companies honest." For a country that must get health care costs under control, reform without the government plan as an option is irresponsible.

Similarly, President Obama and virtually every Democrat in Congress were right to campaign against the obscene provision in the prescription drug plan, the iconic symbol of the corrupt Republican Congress, that actually prohibits Medicare from negotiating lower prices for drugs. Democrats cannot pass reform without erasing that folly, and gaining lower drug prices for seniors on Medicare and for taxpayers paying much of the tab.

Politically, comprehensive reform can pass only if Democrats unite. The effort to gain bipartisan support was torpedoed by the leading Republican negotiator, Senator Charles Grassley, when he revealed his is true colors by embracing the vicious inanity about "death panels." He aligned himself with the wingnuts, and there is simply no reason or way to negotiate with lunacy. The only thing Senator Max Baucus has achieved with his supposed negotiations is endless delay. The only thing he promises is more delay. Conservative Dems now are trotting out an ill-defined national co-op as an alternative to the public option. Most experts dismiss this as unworkable. More to the point, the Republican National Committee scorns it as a "government take over of health care." Negotiations and concessions have produced zero Republican commitments to join reform.

Instead it is time for Democrats to unite and move. Pass a bill out of the House and put it before the Senate with the president behind it. Push the minority of Democrats standing in the way to join the majority. Then let Republicans try to filibuster it. Even if against parts of the bill, no Democrat with a working frontal lobe will vote for the filibuster and join Republicans to deny the president a majority vote on this critical reform. If Kennedy and Byrd are unable to vote, then we'll need two Republicans. The few that haven't gone over to pure obstruction will have to decide if they are prepared to stop a vote on reform. If the filibuster is defeated, then we just need 50 votes to pass the bill - and there is no reason why a bill with a robust public option and lower prescription drug prices can't gain 50 votes from Democrats in the Senate.

Admittedly this is still a heavy lift. But the reality is that a plan without a public option cannot and should not get through the Congress. Over 60 House Progressives have made it clear that they won't vote for a plan without a robust public option. That isn't not a minority standing against reform; it is a minority expressing the majority opinion in the House, the party, and the country. (To support the progressive legislators that are leading this go here.)

Why would a handful of Blue Dogs get in the way of a unified position? A government plan as an option isn't a difficult political vote. The hard choice is voting for any comprehensive reform -- and they will pay a much higher political price for failing to produce than for voting for a public option. The only reason to block a plan is either ideological rigidity, or the corrupting influence of insurance company contributions. In this circumstance, citizen mobilization can help educate the recalcitrant on the need to join the president and the majority of the party.

Less than a Full Loaf

Some reporters suggest that Obama is signaling that he's ready to abandon the public plan. In fact, Obama has been consistent. He has argued for the public option, while stating that he's prepared to negotiate any part of the deal to get majority support for something that works. He's for a public option, but it isn't a deal breaker for him.

Former President Bill Clinton came to the Netroots Nation convention last week. He was in his full glory - smart, funny, wounded, a repository of policy and politics. His core message was that it is "imperative for the Democrats to pass a health care bill now," telling bloggers that "the president needs your help and the cause needs your help." Since we need reform to pass, he argued, we can't let the perfect be enemy of the good. So Clinton urged the liberal activists to keep fighting for what they want, but be ready to accept "less than a full loaf." This is a message better delivered by the former president to his old Blue Dog and New Dem gang - to the handful of conservative Dems standing in the way, not to folks supporting the broad majority in agreement with the president.

And Clinton inadvertently sent the bloggers a very different message. Lane Hudson interrupted his speech to challenge him on the unconscionable "don't ask, don't tell" policy on gays in the military. Clinton's famed temper flared as he defended himself:

"You wanna talk about "Don't Ask, Don't Tell." I'll tell you exactly what happened. You couldn't deliver me any support in the Congress and they voted by a veto-proof majority in both houses against my attempt to let gays serve in the military, and the media supported them. They raised all kinds of devilment. And all most of you did was to attack me instead of getting some support in the congress. Now, that's the truth."

Well, not quite, since many of the bloggers in the audience were teenagers or younger when this debate took place. But the former president provided clear strategic insight for the current moment. We don't want a former President Obama to say, a decade from now, that the reason we didn't get a public option was that we "couldn't deliver" any support for him in the Congress. It's time to deliver that support.

So no surrender; no retreat. Don't start embracing "half a loaf," or thumb-sucking about the reasons for the demise of the public option. Real reform has the support in the country, the Democratic Party, the House of Representatives and the White House. It has support of a majority of Democrats in the Senate. Now it is time to deliver the president the votes he needs for the public option he favors. Full court press on the handful of Democrats that are standing in the way, and then real pressure on the two or three Republicans who have yet to surrender to the obstructionist extremes of their party.

Pull out the stops. Do whatever you can think about doing to weigh in at this time - and then enlist your friends to join you. We are very close. We don't have to overcome a presidential veto, or the opposition of the congressional leadership. All we need to do is to get Democrats and a couple Republicans to commit to giving the president a majority vote on this critical reform, and then get 50 members of the Senate to join the majority of the House in supporting it. Forget the naysayers. This is in reach. Let's make it happen.