By Don Klein
Finally, the Democrats seem to have come up with a winning formula for the highly contentious issue of providing health care for all. Senate majority leader Harry Reid has announced that the bill which will be presented to the full Senate will include a public option with a contingency for states to opt out of the program if they deign to do so.
It is more than just a political victory for liberals in Congress who fought so ardently for a public option in order to give teeth to the pending legislation. It also puts the Republican opposition as well as those Blue Dog Democrats on the spot.
It has thrust the issue of health care into the final crucial crunch.
Permitting individual states the right to bail out of the program is a clear boost to the concept of states rights, a point the opposition often uses to justify resistance to the concept of the bill. Now we will learn if the opposition is really opposed to health care legislation because it is unpopular among the residents in their states or if it is because the solons are satisfactorily impressed (paid off) by the powerful, well-heeled insurance lobby.
The Reid compromise is attractive because it ultimately allows the people to decide the issue. In states that accept the public option, which will be most of them, we should start seeing the uninsured becoming insured and further, the insurance premiums for all others to begin to show cost reductions. If for some strange reason this does not benefit the public, the states can always opt out.
In those states that opt out from the start there will be a different consequence. Their rates may remain where they are or might even increase because there will be no public competition on costs. Eventually the residents of opted out jurisdictions will realize they are paying a surcharge that others are not and they will demand to be included. State governments will not be able to resist these movements and still remain in office very long.
My guess is that many voices will be heard and soon all states, except the most stubborn, will rejoin the program which includes a public option. Give them five years and the public option will be uniform throughout the country.
So the opt out clause is good. To begin with, it will be hard to oppose because if you don’t like it you don’t have to accept it. And more importantly, it will be the first step towards affordable health option insurance for the entire country.
But Reid’s plan is still not the law of the land. There is a question whether it will pass Congress because of recalcitrant Republicans. There is another problem that needed to be faced from the very beginning. The Democratic caucus is still not unified behind the bill despite having a filibuster-proof majority of 60. There are still three or four Democrats (Sens. Landrieu, Lincoln, Nelson or Baucus) who are uneasy with the public option and one of the two independents (Sen. Lieberman) is a holdout.
No one expects any help from GOP senators despite Olympia Snowe’s positive committee vote recently. If she backs down, as she has threatened to do, so be it. This issue will come down to the effort put into it by President Obama using his immense patronage powers.
He must invite each of the unsure Democrats to the Oval Office, or send his envoys to Capitol Hill, and use gentle persuasion on them, reminding each marginal senator of what the power of the presidency can do in each of their home states. No politician in his or her right mind wants the president, especially of his own party, angry with them.
They will have to balance the benefits of an insurance industry which can provide funds to support their next political campaign against the extraordinary benefits to their states possible through White House largesse. This might even move rebellious independent Joe Lieberman, who represents the insurance industry-based state of Connecticut, to a positive position.
All that is needed is 60 votes to clear cloture then a simple majority of 51 is needed to pass the bill. The Democrats are certain of the latter number.
The opt-out concept makes a great deal of sense but you can bet it will not impress the Republicans. Even though it illuminates their states rights position on so many other matters, the GOP is only interested in one thing – how to make Obama appear to be a failure. They are afraid if the president succeeds they will remain a minority party for years to come.
If health care reform fails, they see the Democrats on the ropes during the 2010 elections. Winning or losing elections are more important than doing what is right for the public.
This entire issue of health care in America is loaded with ruptured axioms:
1. America thrives on competition – except when it comes to health care issues.
2. Rationing is bad -- except when insurance companies do it for profit.
3. States Rights are all important – except when providing for the needy.
4. Senior citizens enjoy a single-payer health plan, as does Congress -- but it is not good for the general public.
If this health care effort founders or is substituted with a feeble, industry-favored substitute which does not include any method to insert real competition into insurance charges I would be hopeful every member of Congress – Republican or Democrat -- who voted against the measure is justly defeated in the 2010 election because they dismiss the personal well being of their constituency as not important.