The Democrats’ Lost Opportunity on Health Care

Writing in Kaiser Health News, Jonathan Cohn of the New Republic makes an important point about the process of health care reform. If Obama had not been so intent on winning bipartisan support, Cohn contends, the Democrats could have won the day without making the kinds of backroom concessions–including the so-called cornhusker deal in Nebraska–that have served to alienate even some supporters of reform. Here’s Cohn’s argument:

Remember how we got to this point–and how far President Barack Obama and the Democrats have gone to accommodate Republicans and the conservatives they represent. The plan Obama outlined on the campaign trail, the one Democratic congressional leaders endorsed, called for making sure nearly every American had insurance. But accomplishing that would have cost well over $1 trillion over 10 years and, by some estimates, closer to $2 trillion. That was more than conservatives could stomach. To get the price tag down below $1 trillion, they settled on a plan that covered far fewer people.

The original Obama and congressional plans all called for creating a public insurance option, into which people could enroll voluntarily. But that proposal, too, ran afoul of more conservative sensibilities–and was summarily dropped. (The House ended up including a public plan as part of its bill, but House leaders signaled long ago their readiness to drop it in order to reach a compromise with the Senate.)

These moves didn’t make health care reform more popular. If anything, they had the opposite effect. A plan that spent more money would have required finding more offsetting revenue or savings. But it also would have provided clearer, quicker benefits for middle-class people–many of whom now fear the bill does too little to improve their lives. As for the public plan, poll after poll has shown that it is popular. And the really crazy thing is that the Democrats might have been able to keep both features–with, at most, minimal compromises–if only they’d been willing to go it alone, the way the critics insist they did.

Under Senate procedures, the Democrats had the option of passing health care reform, or at least many of its elements, through what’s called the reconciliation process. In reconciliation, a simple majority of senators can pass a bill, without the threat of a filibuster. Rules limit what can and can’t be considered during the process, so it has definite drawbacks. But if Democratic congressional leaders were determined to pass something on their own–the way, say, Republican congressional leaders were frequently during the Bush years–they could have gotten much and maybe most of what they wanted.

But they didn’t–in no small part because they didn’t want to act in such a blatantly partisan way. Whether that was a matter of principle (i.e, they really believed bipartisanship is important) or a matter of perception (i.e., they thought voters would get mad), it ended up constraining them all year long. Instead of wrapping up negotiations and passing bills before the summer was over, the process dragged into the fall and winter. Over and over again, Democratic leaders (particularly Senate Finance Chairman Max Baucus) reached out to Republicans, only to be rebuffed. When that didn’t work, they were left trying to deal with the most conservative members of their own caucus–culminating in the negotiations with Nelson and the promise to cover his state’s Medicaid expansion. If Senate Democrats hadn’t needed Nelson’s vote to break the expected Republican filibuster–if they could have passed health reform with a “mere” 59-vote majority–they could have told Nelson to take a proverbial hike. 

2 responses to “The Democrats’ Lost Opportunity on Health Care

  1. The ongoing attempts at bipartisan politics are largely based on Obama’s mode of operation. He seems genuinely interested in being inclusive even when he should realize that the door should be shut to those who are not interested in negotiation. This mindset may have served him well in the past, but seems ineffective with the Republicans more interested in gaining political support that supporting change.

  2. The country can’t afford the bill presented. We need to balance the budget while enacting smart reforms along the way.

    I don’t want doctors saddles with expanded Medicaid cases. Those reimbursement rates are too low and hurt the quality of care.

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