Monday, June 22, 2009

America's other health care crisis: Senate Democrats have no backbone

Our Democratic President wants universal health care insurance for Americans. The American people are expressing clear support for this goal. Democrats in the Senate support health care reform, but they aren't on board with the President's plan. However, they haven't agreed on an alternative plan of their own either; instead they're squabbling over a number of different proposals. Republicans of course are against health care reform. They don't believe America is in a health care crisis. Republicans in Congress are gearing up to oppose any Democratic plan that comes to the floor of the Senate. Of course if the Democrats remain so disorganized that they can't actually bring any of their plans to a vote, the Republicans don't have to do anything.

The eight sentences above explain why the Clinton health care proposal of 1994 failed. Unfortunately, these same eight sentences also describe the current state of President Obama's health care proposal.

"Health care is a right." That was the clear message of the Obama campaign in 2008.

Before we go any further, let's review some facts:

America spends two to three times as much as other leading industrialized nations on health care costs per capita. Despite this, nearly one in five Americans under the age of 65 are without health insurance. We have an infant mortality rate that is higher than Cuba or Slovenia and about twice as high as Japan. The main reason why we spend so much and get so little? It's the fact that 31% of health care costs in this country are not for health care, but instead for administrative overhead costs incurred as a result of our perpetual war between providers of health care and the private insurers that they are trying to get to pay for that care.

To my mind, these facts point to a health care crisis in this country that calls for sweeping reform. Of course the Republican Party didn't agree that reform was needed when the Clinton administration proposed it in 1994, and they don't agree today. But I digress. For once, I'm not writing to beat up on the GOP, I'm writing to beat up on certain Democrats.

Before I talk about the Democratic Senators who are foot-dragging on the President's plan, let's review what the plan is. Obama has proposed a National Health Insurance Exchange that would include both private insurance plans and a Medicare-like government run option. Coverage would be guaranteed regardless of health status, and premiums would not vary based on health status either. For the record, this is a great plan and I support it.

Here's a great summary about how the plan works from Jacob Hacker of the The New Republic: "If you don’t have coverage from your employer, you can choose from a menu of health insurance products that includes not just a range of private health plans but also a public insurance plan provided on the same terms nationwide.

The argument for this new public plan is that it would have lower administrative costs; greater leverage to hold down prices; and the transparency, broad patient data, and incentives for long-term investment in health to improve the quality and efficiency of care. Along with new regulations, it would also be the primary check on a private insurance industry that has, for too long, neglected both quality and efficiency, focusing its creative energies instead on new ways to shift costs onto and screen out the sick."

Allowing everyone to buy into a public insurance program if they so choose is known as public option. And how do Americans feel about public option? Overwhelmingly, they support it. So you would think that Congress would be ready to get behind the President's plan. Democrats in the House have done just that, drafting a bill includes a robust public plan that would operate nationally and compete with private insurers.

Meanwhile in the Senate, spineless Democrats are calling public option dead on arrival. Kent Conrad, for example, is proposing a plan that would allow consumers, states, and anybody else so inclined to create cooperatives that would purchase health care for their members. Why does his plan not include public option? Because, according to Conrad, public option doesn't have the votes, with all Senate Republicans and at least three Democrats opposed to it.

Senator Max Baucus, Chairman of the Senate Finance Committee and a Democratic moderate, has also stated his support for killing public option. Just today, Senator Feinstein of California, who is hardly a conservative, downplayed the possibility of the Obama plan becoming law because she doesn't know that the President, "has the votes right now."

So nearly half the Senate, including some Democrats are totally opposed to public option, even thought it enjoys the support of the President and the public? How can this be? Well, for an explanation, let's return to the Jacob Hacker article I cited earlier:

"The idea of public plan choice was part of all the leading Democratic candidates’ health plans, Senator Max Baucus’ November 2008 White Paper, and the vision of reform articulated earlier this year by key congressional Democrats. All with little attention outside health policy circles--until conservatives, health insurers, and some provider groups decided the public plan was public enemy number one. And so, the misinformation campaign began: A public plan available alongside private plans only for Americans without workplace insurance was suddenly described as a "government takeover” of medicine, the "road to rationing," and (that old standby) "socialized medicine." Republicans drew their lines in the sand, and Democrats started their favorite parlor game: compromising among themselves even before the real debate begins."

The spinelessness that Conrad, Baucus, Feinstein and others are showing on this issue is unbelievable. Apparently, they not prepared to even try to rally support for Obama's plan.

So, are we getting the Conrad co-op plan, that some are now claiming is the only compromise bill with any chance of passage? Actually, there's no reason to think that we will in fact get the Conrad plan, since there's no indication that it enjoys broad support in the Senate. Meanwhile, there are other plans in the Senate. A lot of other plans. Senator Kennedy has proposed a plan that requires private insurers to insure everyone, but his plan like Conrad's does not provide a public option. Senator Rockefeller has proposed a plan that, to its credit, does include public insurance.

So 2009 is shaping up to be exactly like 1994, when Democrats couldn't agree on a health care compromise and eventually gave up completely. Apparently, Senate Democrats may once again be too incompetent and spineless to bring any bill at all to a final vote. No wonder Republicans don't seem worried about opposing health care reform. Why should they be afraid to oppose what the public wants and needs if they never have to cast a vote?

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