Policy wonks agree: Pass (and then fix!) the Senate health reform bill

This is a tough moment in the health care fight. It is not the toughest moment--or at least it does not have to be. Corresponding with policy wonks, advocates, public health and medical folks who hold a broad range of ideological views, I am struck that virtually every person I talked with recommends that Democrats do the same three things:

1. Calm the heck down, show that we can take a punch, and regain our composure.
2. That the House of Representatives quickly pass the valuable but flawed Senate bill, and
3. Fix the flaws of that bill through the reconciliation process.

Since we heard such agreement, Tim Jost and I drafted a simple letter and sent it to policy wonks we knew, asking for an immediate sign on. We got fifty responses virtually immediately from people across the political spectrum who have varying views but who are deeply committed to seeing health reform become a reality.

Many of the signatories are quite familiar to HuffPo readers: Dean Baker, Jerome Karabel, public option guru Jacob Hacker, Theda Skocpol, health economists Henry Aaron, David Cutler, and Jonathan Gruber, Political scientists Ted Marmor, Jon Oberlander, and Paul Starr. Some others are less familiar but are often equally important in the worlds of medicine and public health. I am especially proud to have Anna Burger of SEIU on this list. Without SEIU's support and hard work over many years, health reform would be impossible.

Our petition is shown below. There's nothing there that Jonathan Cohn, Ezra Klein, and many others in the liberal blogosphere haven't already said. After a day of phone calls, I have no doubt that our letter reflects the broad consensus of the progressive policy community, and of millions of people of both political parties who desperately need help.

Some of my friends have asked what we, as individuals, can do. Each of us can call our Senators and representatives today and ask them to support House passage of the Senate bill, followed by a serious fix in the reconciliation process.

Progressive Representatives need your encouragement and cover to cast this vote. This is not an easy vote. I am well aware--as are many signatories--of the significant defects in the Senate bill. Despite key shortcomings that require repair, enacting this bill would be a historic progressive victory and would provide coverage to millions of uninsured people.

No less important, moderate Democratic Representatives need to know that refusal to sign on to a moderate Senate bill is indefensible.

Opponents of health reform are active and organized. We need to be more active and more organized, and more focused on the immediate task at hand. One House vote puts an imperfect but historic package on the President's desk. We took a punch in Massachusetts. We're too close to lose heart or to abandon the fight.

Congresswoman Nancy Pelosi
Speaker of the House of Representatives
235 Cannon House Office Building
Washington, DC 20515

Congressman Charles Rangel
Committee on Ways & Means
U.S. House of Representatives
1102 Longworth House Office Building
Washington D.C. 20515

Congressman Henry A. Waxman
Committee on Energy and Commerce
2204 Rayburn House Office Building
Washington, D.C. 20515

Congressman George Miller
Committee on Education and Labor
2205 Rayburn House Office Building
Washington, DC 20515

Dear Speaker Pelosi and Chairmen Rangel, Waxman, and Miller:

For nearly three-quarters of a century, Presidents and Congressional leaders have tried to enact legislation that would make health care accessible to Americans. Although pieces of this dream have been realized--health care for the elderly, the disabled, and children in low-income families--universal coverage itself has proved beyond reach.

We are now on the cusp of realizing this goal. Both houses of Congress have adopted legislation that would provide health coverage to tens of millions of Americans, begin to control health care costs that seriously threaten our economy, and improve the quality of health care for every American. These bills are imperfect. Yet they represent a huge step forward in creating a more humane, effective, and sustainable health care system for every American.

We have come further than we have ever come before. Only two steps remain. The House must adopt the Senate bill, and the President must sign it.

While the House and Senate bills differ on specific points, they are built on the same framework and common elements--eliminating health status underwriting and insurance abuses, creating functioning insurance markets, offering affordability credits to those who cannot afford health insurance, requiring that all Americans act responsibly and purchase health insurance if they are able to do so, expanding Medicaid to cover all poor Americans, reforming Medicare payment to encourage quality and control costs, strengthening the primary care workforce, and encouraging prevention and wellness.

Some differences between the bills, such as the scope of the tax on high-cost plans and the allocation of premium subsidies, should be repaired through the reconciliation process. Key elements of this repair enjoy broad support in both houses. Other limitations of the Senate bill can be addressed through other means.

The Senate bill accomplishes most of what both houses of Congress set out to do; it would largely realize the goals many Americans across the political spectrum espouse in achieving near universal coverage and real delivery reform.

With the loss of Edward Kennedy's Senate seat, Democrats no longer enjoy a filibuster-proof Senate majority, though they still enjoy the largest Senate majority any party has achieved in the past generation. The loss of this one vote does not require Congress or the President to abandon Senator Kennedy's life work of health care reform. A year of political infighting, misleading debates about death panels and socialized medicine, and sheer inaction has left Americans exhausted, confused, and disgruntled. Americans are also bearing the severe consequences of deep recession and unemployment. Still, a majority of Americans support the elements of the Senate bill.

The House of Representatives faces a stark choice. It can enact the Senate bill, and realize the century-old dream of health care reform. By doing so, it can achieve a historic milestone while freeing itself to address other national problems such as joblessness and mortgage foreclosure that affect millions of Americans. Differences between the House and Senate bill can be negotiated through the reconciliation process.

Alternatively, Congress can abandon this effort at this critical moment, leaving millions more Americans to become uninsured in the coming years as health care becomes ever less affordable. Abandoning health care reform--the signature political issue of this administration--would send a message that Democrats are incapable of governing and lead to massive losses in the 2010 election, possibly even in 2012. Such a retreat would also abandon the chance to achieve reforms that millions of Americans across the political spectrum desperately need in these difficult times. Now is the moment for calm and resolute leadership, pressing on toward the goal now within sight.

Some have proposed dividing the bill or starting anew with negotiations to produce a less comprehensive bill. From the perspective of both politics and policy, we do not believe this is a feasible option. We doubt that the American public would welcome more months of partisan wrangling and debate. We doubt that the final product would match what has already been achieved. Indeed we doubt that any bill would reach the President's desk should congressional leaders pursue this misguided course.

We, the signatories of this letter, come from a variety of different perspectives. Some of us are long-standing advocates of progressive causes. Some of us are nonpartisan or identify as political moderates.

From these differing perspectives, we agree on one thing: the current choice is clear. Pass the Senate bill, and improve it through reconciliation.


Henry J. Aaron, Brookings Institution
Ronald Andersen, UCLA
Gerard Anderson, Johns Hopkins University
Dean Baker, Center for Economic and Policy Research
Ronald Bayer, Columbia University
Anna Burger, Secretary-Treasurer, SEIU
David Cutler, Harvard University
Linda C. Degutis, Yale University
Judith Feder, Georgetown University
Eric Feldman, University of Pennsylvania
Thomas Fisher, University of Chicago
Brian R. Flay, Oregon State University
David Grande, University of Pennsylvania
Thomas Greaney, St. Louis University
Colleen Grogan, University of Chicago
Jonathan Gruber, MIT
Mark A. Hall, Wake Forest University
Jacob S. Hacker, Yale University
Jill Horwitz, University of Michigan
James S. House, University of Michigan
Peter Jacobson, University of Michigan
Timothy Jost, Washington and Lee University (organizer)
Theodore Joyce, CUNY
George A. Kaplan, University of Michigan
Jerome Karabel, University of California at Berkeley
Mark A.R.. Kleiman, UCLA
Paula M. Lantz, University of Michigan
Simon Lazarus, NSCLC
Arleen A. Leibowitz, UCLA
Theodore Marmor, Yale University
Lynda Martin-McCormick, NSCLC
Michael L. Millenson, Northwestern University.
James A. Morone, Brown University
Len M. Nichols, New America Foundation
Jonathan Oberlander, University of North Carolina at Chapel Hill
Mark A. Peterson, UCLA
Karen Pollitz, Georgetown University
Harold Pollack, University of Chicago (organizer)
Daniel Polsky, University of Pennsylvania
Sara Rosenbaum, George Washington University
Meredith Rosenthal, Harvard University
Lainie Friedman Ross, University of Chicago
William Sage, University of Texas
Theda Skocpol, Harvard University
Paul Starr, Princeton University
Donald H. Taylor, Jr., Duke University
William Terry, Brigham and Women's Hospital
James A. Tulsky, Duke University
Alexander C. Wagenaar, University of Florida
Joseph White, Case Western Reserve University
Celia Wcislo, 1199-United Healthcare Workers East, SEIU

(Institutional affiliations listed for identification only).

cc. Senator Harry Reid
President Barack Obama