The best path forward on health care reform
by desmoinesdem, Wed Jan 20, 2010 at 04:15:12 PM EST
Even before the Bay State debacle, Democrats faced no easy path forward on health care reform. If House Democrats like Bart Stupak, Anthony Weiner and Jerrold Nadler are to be believed, there are not 218 votes in the House for passing the Senate health care bill unchanged. Nor should there be, given the weak state-based exchanges in that bill and an excise tax that will encourage employers to downgrade the coverage they provide. Accepting a promise from the White House that problems will be fixed later would be idiotic. If the president didn't keep his campaign promises to let Medicare negotiate for lower drug prices or allow re-importation of prescription drugs from Canada, why would he keep any promises made to House Democrats now?
Key labor leaders are calling on Congress to pass a separate bill through the reconciliation process (requiring only 51 votes), while "simultaneously" passing the Senate bill in the House. I don't know what they have in mind for that separate bill besides fixing some of the problems with the excise tax on expensive health insurance policies.
Ezra Klein would prefer something like what labor is advocating (House swallows Senate bill, hopes for fixes through reconciliation), but the other option he lays out here seems far superior to me:
Democrats could scrap the legislation and start over in the reconciliation process. But not to re-create the whole bill. If you go that route, you admit the whole thing seemed too opaque and complex and compromised. You also admit the limitations of the reconciliation process. So you make it real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy.
And that's it. No cost controls. No delivery-system reforms. Nothing that makes the bill long or complex or unfamiliar.
I would add a few more things to that smaller bill, like the money for primary care clinics that Senator Bernie Sanders has been fighting for.
Democrats could then offer the insurance reforms you can't pass through reconciliation as regular bills. Will the Republicans dare to vote against allowing re-importation of prescription drugs, or revoking the insurance industry's anti-trust exemption? Will they dare to vote against banning insurance companies from discriminating because of pre-existing conditions? I don't think so. We should be able to get 60 votes for all of those reforms and more. If we can't, everyone will be able to see who stood up for consumers and who voted to protect corporate interests.
The smaller bill wouldn't solve all of the status quo problems with health care delivery, but neither would the Senate bill. Politically, this course would be less risky as well.
Feel free to tell me why I'm wrong in the comments.