The last committee hurdle has been jumped. The Senate Finance Committee has reported a bill. It’s not great. It’s not we want. But it moves us a step closer to the real reform we must get in 2009.
I want to give you some idea of how we are going to get the reforms we want this year.
What we know and don’t know
Now if anyone tells you he knows what will happen in Congress this year on health care, he or she is not to be trusted. As Yogi Berra once put it, predictions are hard, especially about the future. And they are especially hard in politics, where so many factors—ideology, interest, ambition, and skill—play a role in determining what happens, especially on issues as difficult and complicated as health care.
But I do have a sense of how things will play out this year and I want to give you one scenario, not because I’m really sure about it, but because I do think you have to be prepared for the next two months.
You have to keep the faith against the strategy of the insurance companies and right-wing ideologues.
And the reason you have to be prepared is that this is not likely to be a pretty process and there will be moments when you may be upset and frustrated. It is absolutely critical that, at that point, you not give up hope and that you keep fighting.
You need to keep in mind that, all along, a key part of the strategy of those who oppose health care reform has been to discourage us by dragging the process out and making it seem as if we could not win. (By the way, Wendell Potter, the former CIGNA communications executive, confirmed that this is exactly what the insurance companies planned to do.)
- That’s why the insurance companies and ideological conservatives did everything they could to delay action at the end of July.
- That’s why they shoveled money into the hands of the right wing front groups that came out to disrupt Congressional town halls in August.
- That’s why they keep having their flacks say that the public health insurance plan is dead.
- And that’s why they released a report last week that opposed the Senate Finance Committee bill, even though it is far too favorable to insurance companies.
I know that each of these moment have been frustrating for you.
Why progressives are prone to frustration.
Indeed, I think we progressives are prone to frustration in a way that the conservatives are not. We know that the policies we support are morally right and economically sensible and not only will benefit the vast majority of Americans but are supported by them. So when the process moves slowly or when there is a temporary setback, we start to lose hope. And we wonder where we have gone wrong.
We forget that it’s not just good and popular ideas that create public policies. We forget that conservatives are able to use their shameless lies, the immense financial resources they have for organizing and campaign contributions, and all the feature of the American political system that slow down action—bicameralism, the committee system, the filibuster—to block us.
We also forget that not everyone agrees with us, that people brought up in political traditions different than our own, find some of the conservative arguments, and even their lies, plausible. So we are shocked and disappointed when opposition arises to our ideas. And we start to question our own political strategy and message.
You should remember that the people who designed this strategy never believed that the kind of progressive change we support was going to be easy or that, with our anti-government traditions, all Americans would embrace our ideas.
The conservatives, on the other hand, know their ideas aren’t popular beyond the minority of the minority party. So they don’t give up when they see little popular support for their ideas. They know that they have to rely on relentless organizing and shameless messaging to advance their policy proposals and block ours. And they just keep going no matter what.
That’s what we have to learn from them. We have to keep going, push harder and harder, and never, ever give up.
What’s Wrong with the Senate Finance Committee Bill
And we have to do everything we can to do better than the bill that came out of the Senate Finance Committee. As I predicted long ago, it is the worst of the five bills that have come out of committee.
- It doesn’t have a public health insurance option.
- It doesn’t require all employers to provide insurance to their employees to avoid a fine or tax. Indeed, it has provisions that will discourage employers from hiring low-wage workers.
- It doesn’t guarantee that insurance sold in the exchange will be affordable. The House bills and the Senate HELP committee bill set lower limits on the percentage of income people have to pay for premiums and for out-of-pocket expenses.
- It taxes so-called “Cadillac” insurance plans but defines them in a way that will tax the health insurance plans of many middle class families and union members. We prefer the tax burden to be placed on those with very high incomes as in the House bill, which puts most of the burden on families with over $1 million in income.
The Road from Here: Inching to Success
So here is one possible scenario about how we can get something much better than the Senate Finance Committee bill.
Senate
The first step, which will take place in the next week or two, is for the Senate leadership to meld Senate Finance and Senate HELP Committee bills.
Harry Reid, the Senate majority leader, has been moving closer and closer to becoming a real champion for health care reform. But he has to reach a balance between what he and we want and what he thinks he can get through the Senate right now.
We would like to see the public option and the HELP Committee affordability and employer responsibility provisions in the melded bill. We expect that the bill that goes to the floor will be much better than the Senate Finance bill. But it probably will not have everything we want.
In particular, in an effort to guarantee that the bill will have the sixty votes it will need at least twice to overcome a filibuster, there may be some compromise on the public option. There may be a trigger proposal that puts the public option into place only in states where insurance remains unaffordable. Or there may be a provision that allows states to opt out of the public health insurance plan.
Something similar could happen with other provisions.
We don’t want any compromises over the public option or affordability or employer responsibility. And we are going to urge Senators to vote for an amendment that makes the bill closer to what we want and, in particular that creates a robust public option that can negotiate provider rates that are close to Medicare rates. Such proposals will, the CBO tells us, save a hundred million dollars over ten years.
A robust public health insurance option will, we think, get a majority of the vote and possibly 54 or more votes. So will better employer responsibility and affordability provisions. But the public option and some of the other provisions we want may not have enough votes to get into the Senate Bill
House
On the House side, we think a very strong bill close to the bill that came out of the Ways and Means and Education and Labor Committees will be passed. That bill will have strong public option, good employer responsibility and affordability provisions, and a much more progressive tax plan than the Senate bill.
Conference Committee
The House and Senate bills will then go to a conference committee. And here, precisely because of the majority votes in the Senate for a public option and other provisions we want, there will be an enormously strong case to make the bill look more like the House than the Senate bill. In particular, we think the public option will be in the conference committee bill.
Back to the House and the Senate
The conference committee bill will then go back to the House, where it will undoubtedly pass.
And then all eyes will turn to the Senate. We will not need all of the Democratic Senators to vote for the bill. But we will have to win one cloture vote to block a filibuster. And the pressure on Democratic Senators and the two Maine Republicans to vote to end a filibuster will be intense. For this one vote will determine
- Whether we achieve the historic goal of providing quality affordable health care for all, a goal for which we have all worked so hard this year.
- Whether the Democratic party proves it can move this country in a progressive direction.
- Whether the Obama administration will be a success.
The Senate Democratic leadership will put immense pressure on Democratic Senators.
Major Senate campaign contributors will tell wavering Democratic Senators that they must vote for cloture.
President Obama will, we hope, move at this to the forefront in the battle and use all his persuasive power and his control over so many things important to Senators to secure their votes.
Most importantly, all of you will be—as you have been throughout the process—working as hard as you can to tell our Senators to do the right thing and take this historic step.
And we will win.
What you have to do
This is only one possible scenario that leads to victory. There are others as well. All of them are similar in that we are likely to move step by step and, at times inch by inch, towards what we really want in the legislation. And that means we are going to have to keep fighting again and again even when we are frustrated by slow progress.
None of these scenarios give us a sure thing.
But all of them presuppose a few things:
- That you and people like you will not give up hope.
- That you and people like you will keep calling, writing, and emailing our Senators and members of Congress.
- That you and people like you will continue to take part in rallies and other events.
- That you and people like you will keep phone banking into key Congressional districts and states.
- And that, as we move closer to the finish line, and more and more people want to take part in this effort, you and people like you will reach out to your friends, neighbors, and co-workers, engage them in Health Care For America Now campaign and encourage them to take part in all these actions.
There are no guarantees.
But, if you do your part, I really do think we will win and enact legislation that will save thousands of lives a year and dramatically improve the well being of millions of working and middle class Americans.
It won’t be the end of health care reform. It won’t create a perfect world. But this legislation not only will make things better for millions of us, it will create its own pressure to be expanded and improved. And it will re-legitimate the use of government to make our individual and collective lives better.
And that’s no mean feat in American politics.