I want to report to you on where the health care bill is as of this moment. The news is not as good as I hoped it would be. But there is every reason to keep working hard to make this legislation as good as possible.
Difficulties in enacting the public option
Right now, we don’t have a fool-proof strategy for getting sixty votes for the public option in the Senate or for a Medicare buy-in for people 55 to 65. One Senator, Joe Lieberman, has said that he will not vote for the bill with either provision. Another, Ben Nelson, might be a problem as well.
Our HCAN partners in Connecticut and Nebraska are doing everything they can to move them. But, ultimately, there is a limit to what anyone can do. Constituents of these Senators, Senate Majority Leader Harry Reid and President Obama all have some influence over them. But, ultimately it is Lieberman and Nelson who hold the office and decide how to vote. And at least Lieberman has made clear that he is prepared to take down the whole bill if he does not get his way.
Lieberman’s position is inconsistent with what he has said in the past. It seems to come not from any principle or even a concern for the insurance companies in Connecticut but, rather, out of spite for the left wing of the Democratic Party. It is morally appalling. And it should be punished by the Senate leadership.
But the truth is that there is little we can do to move him on the public option.
Where we go from here
So, where do we go from here?
Two pieces of legislation, one from the House and one from the Senate will be merged in discussions among Speaker Pelosi, Senator Reid and the White House, probably starting around December 28.
If we get the right provisions out of this Conference Committee process, even without including a public option, we will have a bill that is worth fighting for. (And there is still some possibility that the Conference Committee will include the public option and the President and Majority Leader Reid will find a way to bring along the last two votes we need in the Senate.)
If the wrong provisions get in the final bill, it will be difficult to support.
Most, but not all, of the better provisions are in the House bill. And that’s why, starting tomorrow, we will ask you to contact House members and will be doing events with them early next week, to encourage Speaker Pelosi stand up for the key provisions in the House bill.
You can find details about the remaining controversies in the legislation and what we think should be in the final bill here. (I’m working on this and the link is coming soon.)
We are not done yet
The key point, however, is that we are not done yet. Six months ago I wrote to you to say that we are going to pass a health care bill but we don’t know how good it will be. That remains true. What happens in the next few weeks will answer that question.
What you do will partly determine what happens and whether we are happy with the result.
What we can still achieve
If we get close to what we want, we will make pass an incredibly important bill.
If the bill looks more like the House than the Senate bill, tens of millions of Americans will have access to affordable health insurance for the first time. An expanded and improved Medicaid will provide access to the lowest income families. Families higher in the income scale will be able to purchase insurance from for-profit or non-profit insurers. This insurance will be made affordable by a new government tax credit. Both individuals and small businesses will be able to purchase insurance in a new Exchange that will give them roughly the same rates that large businesses get for their employees now. Eleven million people will receive new employer-sponsored insurance. And insurance companies will be prohibited from denying people insurance or charging them more on the basis of pre-existing medical conditions, or because they are women. Variation in insurance premiums on the basis of age will be limited as well.
We won’t have the competition of a public option to hold insurance rates down. But a provision likely to be added to the Senate and Conference Committee bill will require insurers to spend about 90% of their premium dollars on health care not administrative or marketing expenses or profits. That will help hold down insurance costs.
This is not all we wanted when we kicked off the HCAN campaign on July 8, 2008. Like you, I’ll be disappointed and angry if we don’t get a public health insurance option. But, as I’ve written before, when was the last time progressive in America achieved so much? .
If we can get make the bill better, we must support it
I know that some of you are so disappointed and angry that you don’t want to accept this half measure. You want Congress to give up on the bill and start over.
This is an understandable reaction. But it is not a defensible in either political or moral terms.
It is not defensible in political terms because defeat for this legislation will not help us pass something better in the future. No one has a strategy that gives us a better bill before the next Congressional election. And, defeating the legislation will cripple the Obama presidency, cost us many seats in the House and Senate next year–which will make health care reform virtually impossible–and guarantee that no future president risks his presidency, as first Clinton and now Obama did, on tackling health care reform.
If, on the other hand, we enact health care legislation that makes the lives of millions of people better, we will make it easier to enact other progressive legislation in the near future, including a jobs bill and energy and climate legislation. And we will create the conditions under which further progressive reform, including improvement in health care, are possible in the longer term.
I’ve not heard a plausible political analysis that explains why giving up on health care reform this year makes sense. But even if someone offered me one, I’d be reluctant to accept it on moral grounds.
Starting over is not defensible in moral terms beacuse we must do everything we can, when we can, to reduce human death and suffering and to give people the health care they deserve as a matter of right. And so I won’t trade off moving towards that goal now, on the basis of any speculative political analysis.
This is no just a matter of abstract principle for me. After seventeen months on this campaign it is deeply personal. Let me tell you why.
During this campaign I’ve traveled from one end to the other of Pennsylvania and back again. In every corner of our state, I’ve met people who suffer because they have no health insurance.
I’ve met people who have to pray that diabetes will not take their leg or kidneys because, without health insurance, they can’t afford insulin.
I’ve met people who are disfigured or crippled because, without health insurance, they could not afford an operation
I’ve met the sibling and spouses of people who died because, without health insurance they could not afford medicine or a new battery for a heart defibrillator.
I’ve met people who are impoverished because a succession of treatable illnesses keeps them from working full time.
Every one of these people wants to see some kind of health care reform happen this year. Unlike some of us who have been lucky in life, they know how important it is to grab what you can now, even if it is not everything you want.
They know that, for millions of people in this country, the line between health and sickness, like the line between a minimal level of comfort and poverty, is extremely thin. They want to make sure we do everything we can, this year, to push as many people as possible over the line.
Even without the public option, the House bill will accomplish that. Assuming the final bill has the key provisions we want in it, I could not look into the eyes of the people I’ve met aroudn the state and tell them I think our members of Congress should abandon it.
Before you say we should give up this year, ask yourself what you would say to one of these people if you had to look them in the eye.
Why I’m not discouraged: our accomplishment
So I’m not backing down in support of this legislation. And while I’m angry, I’m not really discouraged and I hope you won’t be either.
For, first, if we get a decent bill, we will take the most important step towards making this a more just and fair county—other than the civil rights bills—since Medicare was enacted. We will be doing more to improve the well-being of working people and the middle class since Social Security was enacted.
And we will starting to turn this country in a more progressive direction after almost thirty years in which right wing, conservative ideas dominated public discourse and public policy.
These are no mean feats. As angry as I am right now, I know I will soon be proud to be part of accomplishing this. I hope you will as well.
Why I’m not discouraged: what we have been up against
Second, I think we have all learned something important about how difficult it is to make large scale political and social change in America. I’m going to be writing more about why health care reform has been so difficult and won’t say too much about this here.
The serious barriers we have faced are fairly obvious: a difficult and extremely complicated issue that is almost impossible for most of us to understand in detail; powerful interest groups that have enormous resources to block reform; the long standing suspicion most Americans have for new government initiatives, a suspicion that has been exacerbated by thirty years of Reaganism; a Senate that is unrepresentative of the American people and that works under rules that requires sixty votes to accomplish anything; and a few individual Senators whose personal quirks have lead them to oppose us.
That we have gone as far as we have in overcoming those barriers would have been impossible but for the hundreds of thousands of people like you who have taken action, time and again, to demand that our members of Congress push forward towards health care reform.
This has been an education in democracy for all of us that will serve us well in the future. We know, much better than we did, what it takes to change this country. We know, much better than we did, how important our organizing and effort is. We will put those lessons to work in future campaigns, including a campaign to create a public health insurance plan in America.
Stick with it to the end.
But, right now, I’m asking you to stick with this campaign for another few weeks. Don’t let your anger and disappointment lead you to turn away from politics in general or this campaign in particular.
As I said above, we are not done yet. What we do in the next few weeks could make this bill much better or much worse. We have to work together to make it better.