There's so many stories coming out about health reform that the relentless spinning is making everybody's head spin. My own sense continues to be that the Obama administration and the Congressional Democrats are going to pass health reform legislation with a public option this year. I don't know whether Arlen Specter is right in claiming that there are 60 votes to bring a public option plan to a vote if the GOP throws up a filibuster. But I wouldn't be surprised if he was. I also don't know if it's going to be a straight public option, a public option with a mechanism allowing red states to opt out, or a public option with a trigger to go in effect if the health insurance companies continue to conduct their business in a predatory manner. Today's flavor is a public option with an opt out for the benefit of moderate and conservative Democrats who want to hide behind the idea of "choice." However, momentum can shift quickly and I think there's a slightly better chance that the final legislation will contain a straight public option.
My own preference is that the public option be adopted as national legislation. The weakness of the "opt out" is that the states likely to take it are states like Texas and South Carolina that have large minority populations and even larger white populations determined to screw minorities as much as possible. Allowing these states to opt out of the pulbic option is monumentally unfair to large group of working poor among the Hispanic and African-American population. It's unfair to the working white people who can't afford health insurance as well. The politics of a nullification state like South Carolina might militate against accepting a public option, but that doesn't mean that the higher numbers of working poor people in these states should not get the same benefits as people in a wealthy state like Connecticut or Illinois.
But if the public option with opt out is adopted, I believe that it would be politically beneficial to the Democrats. The reason for this is that the acceptance or rejection of the public option would be a powerful wedge dividing the Republicans. This could be seen with the fate of the stimulus package in South Carolina and Alaska. Teaparty governors like Mark Sanford and Sarah Palin wanted to reject stimulus money but this led to howls of outrage among orthodox Republicans in state legislators who wanted the money and were willing to fight their governors over the issue. Health reform is even more unpopular with the teaparty folks and the conflicts among Republicans over opting out would be even nastier. As the fight over Dede Scozzafava in New York's 23rd District shows, the teaparty faction is determined to eliminate moderates from the Republican Party. If a public option "opt out" passes, the teaparty folks are going to start going after "sissy conservatives" as well.
Teaparty activism is part of the dynamic among the Democrats as well. That sound everyone hears in Washington these days is Democratic backbones snapping into place. No one would know this from reading the "progressive media" which over-dramatizes every twist and turn from potential "turncoats" like Ben Nelson, Blanche Lincoln, and Mary Landrieu. But the Democratic and membership in the Senate and House have responded to the Teaparty Movement by tuning out the right-wing. Ben Nelson desperately wants to vote for something Olympia Snowe can support, but Snowe and Susan Collins have become practically the only Republicans on the Democratic radar. When Republican senators like Charles Grassley started going along with the "death panel" lie, the Democrats began to ignore them. People like Nelson and Kent Conrad still have loyalties to the insurance companies, but the Republicans haven't given them anything credible to consider and Democrats in general have closed ranks with the intent of negotiating something among themselves.
The teaparty movement has bee successful in generating grass-roots conservative opposition to health reform, but disgust over tea-party rhetoric among the Democrats has solidified support for large-scale health reform and guaranteed that the public option is going to be passed in some form. America owes the teabaggers a big thank you. As a result of revulsion over the teaparty movement, health reform has "crossed the crossroads" and is on its way to approval.
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I like the public option, it smacks of Rawlsianism to me.
I think we may very well pass meaningful health care reform with a robust public option this year. I do not believe that we have 60 votes in the Senate but that does not preclude passage of a bill with some teeth. Given that historically the President’s party tends to lose seats in Congress we need to get this done now. I can see anything from a net gain of one in the Senate to a net loss of four or five. I suspect we will find ourselves a few seats lighter in the House as well. All the more reason to get this bill passed and signed into law.
As far as a public option with an opt-out provision is concerned, I could live with that though I’d hate to think that some, if not all the red states would exercise this provision. This is very possible. If too many states opt out, reform could be rendered meaningless; as meaningless as that which was passed out of the Senate Finance Committee.
Of course, it is quite possible that most states will choose to stick with the program given the skyrocketing costs of health care, and the chronic nationwide state budget short-falls.
One amendment I would very much like to see as part of the final legislation is the Kucinich Amendment which did not survive the committee vote but which would make more sense in terms of waivers granted to states would have allowed states, with permission from the United States Secretary of Health and Human Services, to opt out of the national program in favor of state-wide single-payer systems. There is nothing unreasonable about this proposal. In fact it would likely cover more people than H.R. 3200 in its current form.
There are innumerable reasons to address the U.S. health care crisis. We’ve heard most of them before: the United States spends more than twice as much per capita on health care as the rest of the industrialized world. According to an Institute of Medicine report, 18,000 Americans die each year because they cannot afford health care.1 And inability to pay for medical bills is the leading cause of bankruptcies – they currently contribute to about half the bankruptcies in the United States. Insurance companies are all for universal insurance as long as it is private. They spend hundreds of millions to oppose real reform. The insurance company lobbies are laying siege to the Senate. Let us hope the lobbyists fail this time.
1http://pnhp.org/excessdeaths/health-insurance-and-mortality-in-US-adults.pdf
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