The politics of health care reform

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Although House and Senate versions of the health care reform bill are weaker than they should be, the legislation making its way to President Barack Obama’s desk is far better than merely maintaining the status quo.

Former DNC Chairman Howard Dean, a physician, said it would be better to do nothing than to enact the Senate version of health care reform. Howard Dean is wrong. It is a gross overstatement to assert that our current system comes close to matching anything being proposed by Democrats and opposed by every Republican senator.

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The major changes are that insurance companies will no longer be able to exclude people with preexisting conditions nor be able to cap the amount of care a person or family can receive in a given year. Those two provisions alone represent a sea of change in American health care.

A serious flaw in the Senate bill is that there is no public option—or government-run insurance plan—that would assure enough competition to hold down premiums, which have been rising in recent years at a rate faster than the cost of living. In addition, a requirement in both bills forcing everyone to purchase insurance or face fines is a bonanza for the insurance industry, providing them with millions of new customers.

Allowing insurance companies to offer plans across state lines may assist in getting premiums to a more reasonable level, but that is not enough. That’s why it’s important to continue to monitor the negotiations over this bill by House and Senate conferees.

Instead of a robust public option favored by progressives, conservative senators substituted a watered down federal health exchange where the uninsured can purchase coverage at a group rate. Less than 5 percent of Americans will be eligible for this coverage.

The Senate bill would allow states to operate these exchanges, which means that national coverage will be uneven. Under the House bill, the exchange would be a national one with the federal Office of Personnel Management negotiating the rates, just as it does for all federal employees, including members of Congress.

Another difference is that the House’s plan to provide subsidies to people who cannot afford coverage is more generous than the Senate bill.

None of the changes will come soon enough. The Senate bill would go into effect in 2014, a year later than what the House proposes.

The wrangling over health care reform exposed major cracks in the fragile Democratic coalition. Will Rogers is remembered for the famous line: “I am not a member of any organized political party. I am a Democrat.” That certainly rang true during this debate.

With 60 votes needed in the Senate to cut off an attempted Republican filibuster, every senator could play an outsized role as Majority Leader Harry Reid tried to hold the coalition together. That’s why, in the end, we saw Bill Nelson of Nebraska, threatening to withhold his vote until he got certain concessions for his state and Joe-the-Traitor Lieberman promising to support a Republican filibuster if the public option wasn’t yanked from the Senate version of the bill.

Rather than risk defeat, progressives held their noses as conservative Democrats gutted some of the most important provisions of the health care reform bill.

We saw similar behavior when the stimulus bill was passed. Coupled with the debate over health care, a disturbing pattern is unfolding. In his eagerness to win over at least some Republicans, President Obama makes significant concessions to conservative Republicans. In each instance, the Republicans initially pretend they want to sign on to bipartisan legislation, but eventually refuse to support the bill even after accommodations have been made for them. That was particularly true during the stimulus negotiations, which ended up with only Maine Sen. Olympia Snowe supporting the legislation. In that instance, Obama was careful to follow the wishes of Snowe.

During negotiations over heath care, it was the president’s own party—along with Democrat-turned independent Joe Lieberman— that almost did him in. Again, progressives—many who claimed they would not support a bill without a public option—caved in. Everything centered around what it would take to keep wavering conservatives on board. Like so many other things, progressives, including the Congressional Black Caucus, were taken for granted. As was the case with Rodney Dangerfield, they didn’t get any respect.

And they won’t get any respect until, like conservatives, they are willing to vote against legislation if their issues are placed on the back burner. Members of the CBC made a step in that direction when they boycotted a House Financial Services Committee vote and threatened to withdraw support for overall banking reform.

Committee Chairman Barney Frank responded to the protest by adding $6 billion to a Wall Street regulation bill to cover job programs, low-interest loans to unemployed homeowners facing foreclosures and neighborhood revitalization programs.

Conservative Democrats were willing to let one of the president’s major legislative priorities go down in defeat if they were not accommodated. Until progressive Democrats are willing to do the same to them, they will continue to be marginalized. And that’s not healthy for anyone.

(George E. Curry, former editor-in-chief of Emerge magazine and the NNPA News Service, is a keynote speaker, moderator and media coach. He can be reached through his web site, http://www.georgecurry.com You can also follow him at http://www.twitter.com/currygeorge.)

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