Congratulations are in order for Scott Brown, who won the special election in Massachusetts and really upset the health reform apple cart. It’s ironic, because Brown opposes the national health reform efforts that practically mirror the state health reform in Massachusetts that he voted for and continues to support. There is commentary aplenty about what exactly it means that a Republican was able to claim a seat held by Ted Kennedy for nearly half a century, in America’s bluest state. Said state is now, I think it’s fair to say, purple. Does this mean the “people have spoken” or that this was “a referendum on health reform” or that “Democrats are out of touch with the American people?” Maybe. Of course, for any of those sweeping statements to be true, we’d have to agree that the people of Massachusetts adequately represent a cross-section of America and that Martha Coakley did everything right in her campaign. I don’t think either of those things is true. And I don’t really care.
The media’s gone on the offensive, hyping Brown’s victory as the death of health reform and searching in Nancy Pelosi’s public comments for what could be evidence of the coffin’s final nail. I and others think it’s all incredibly overblown. The better question is what do the Democrats do now? And as is being widely reported, there are several options.
First, as I previously wrote, the House could vote for the bill the Senate passed on Christmas Eve. This is probably the best option left, substantively, and it’s happened before. The problem with that is, the House bill is much more progressive than the Senate bill, and despite what some people might accuse the party of, there are some Democrats who refuse to compromise any further. So, it doesn’t look like this is going to happen, and Pelosi’s comments seem to be bearing that out.
There’s also the idea of doing things through the reconciliation process, which looks like a possibility. Congressional Democrats might even decide to break the bill up into smaller pieces and pass some of the key reforms that are easily communicated to–and strongly supported by–the public. Then they could build on that. Hooray for incrementalism. (Although some people think such a strategy will never work.)
If you need to buy some time to figure out a strategy, maybe you bring up banking reform to divert people’s attention from health care reform for the moment by focusing on something that all people (save bankers) should–theoretically–support. Or maybe the process should just go forward, forcing the Republicans, who will inevitably vote against the bill, spending all their time explaining why the country doesn’t need insurance reform. If they can pick up a lot of seats in 2010 with that platform, perhaps they deserve to win.
But not so fast. Health reform has suffered a setback, but it is not yet dead. Now is the time for politicians to find creative solutions to the problem. Plenty of people will complain about more compromising–as it has been so one-sided until now–but just letting health reform die is no better. The Democrats have a real chance to lead here and they must. In fact, that’s just what a group of nationally-known health policy experts (including my dissertation committee chair) had to say in a recent letter to Congressional leadership. They urge the House to pass the Senate bill and make subsequent compromises through the reconciliation process. I like their approach and would have signed-on, too, if I were considered enough of an expert to be asked. Here’s what they wrote:
Congresswoman Nancy Pelosi
Speaker of the House of Representatives
235 Cannon House Office Building
Washington, DC 20515
Congressman Charles Rangel
Committee on Ways & Means
U.S. House of Representatives
1102 Longworth House Office Building
Washington D.C. 20515
Congressman Henry A. Waxman
Committee on Energy and Commerce
2204 Rayburn House Office Building
Washington, D.C. 20515
Congressman George Miller
Committee on Education and Labor
2205 Rayburn House Office Building
Washington, DC 20515
Dear Speaker Pelosi and Chairmen Rangel, Waxman, and Miller:
For nearly three-quarters of a century, Presidents and Congressional
leaders have tried to enact legislation that would make health care
accessible to Americans. Although pieces of this dream have been
realized—health care for the elderly, the disabled, and children in
low-income families—universal coverage itself has proved beyond
reach.
We are now on the cusp of realizing this goal. Both houses of Congress
have adopted legislation that would provide health coverage to tens of
millions of Americans, begin to control health care costs that
seriously threaten our economy, and improve the quality of health care
for every American. These bills are imperfect. Yet they represent a
huge step forward in creating a more humane, effective, and
sustainable health care system for every American.
We have come further than we have ever come before. Only two steps
remain. The House must adopt the Senate bill, and the President must
sign it.
While the House and Senate bills differ on specific points, they are
built on the same framework and common elements—eliminating health
status underwriting and insurance abuses, creating functioning
insurance markets, offering affordability credits to those who cannot
afford health insurance, requiring that all Americans act responsibly
and purchase health insurance if they are able to do so, expanding
Medicaid to cover all poor Americans, reforming Medicare payment to
encourage quality and control costs, strengthening the primary care
workforce, and encouraging prevention and wellness.
Some differences between the bills, such as the scope of the tax on
high-cost plans and the allocation of premium subsidies, should be
repaired through the reconciliation process. Key elements of this
repair enjoy broad support in both houses. Other limitations of the
Senate bill can be addressed through other means.
The Senate bill accomplishes most of what both houses of Congress set
out to do; it would largely realize the goals many Americans across
the political spectrum espouse in achieving near universal coverage
and real delivery reform.
With the loss of Edward Kennedy’s Senate seat, Democrats no longer
enjoy a filibuster-proof Senate majority, though they still enjoy the
largest Senate majority any party has achieved in the past
generation. The loss of this one vote does not require Congress or
the President to abandon Senator Kennedy’s life work of health care
reform. A year of political infighting, misleading debates about death
panels and socialized medicine, and sheer inaction has left Americans
exhausted, confused, and disgruntled. Americans are also bearing the
severe consequences of deep recession and unemployment. Still, a
majority of Americans support the elements of the Senate bill.
The House of Representatives faces a stark choice. It can enact the
Senate bill, and realize the century-old dream of health care reform.
By doing so, it can achieve a historic milestone while freeing itself
to address other national problems such as joblessness and mortgage
foreclosure that affect millions of Americans. Differences between
the House and Senate bill can be negotiated through the reconciliation
process.
Alternatively, Congress can abandon this effort at this critical
moment, leaving millions more Americans to become uninsured in the
coming years as health care becomes ever less affordable. Abandoning
health care reform—the signature political issue of this administration
—would send a message that Democrats are incapable of governing and
lead to massive losses in the 2010 election, possibly even in 2012.
Such a retreat would also abandon the chance to achieve reforms that
millions of Americans across the political spectrum desperately need
in these difficult times. Now is the moment for calm and resolute
leadership, pressing on toward the goal now within sight.
Some have proposed dividing the bill or starting anew with
negotiations to produce a less comprehensive bill. From the
perspective of both politics and policy, we do not believe this is a
feasible option. We doubt that the American public would welcome more
months of partisan wrangling and debate. We doubt that the final
product would match what has already been achieved. Indeed we doubt
that any bill would reach the President’s desk should congressional
leaders pursue this misguided course.
We, the signatories of this letter, come from a variety of different
perspectives. Some of us are long-standing advocates of progressive
causes. Some of us are nonpartisan or identify as political
moderates.
From these differing perspectives, we agree on one thing: the current
choice is clear. Pass the Senate bill, and improve it through
reconciliation.
Sincerely,
Henry J. Aaron, The Brookings Institution
Gerard Anderson, Johns Hopkins University
Ronald Anderson, UCLA
Dean Baker, Center for Economic and Policy Research
Ronald Bayer, Columbia University
Anna Burger, SEIU
David Cutler, Harvard University
Linda C. Degutis, Yale University
Eric Feldman, University of Pennsylvania
Thomas Fisher, University of Chicago
Brian R. Flay, Oregon State University
David Grande, University of Pennsylvania
Thomas Greaney, St. Louis University
Colleen Grogan, University of Chicago
Jon Gruber, MIT
Mark A. Hall, Wake Forest University
Jacob S. Hacker, Yale University
Jill Horwitz, University of Michigan
James S. House, University of Michigan
Peter Jacobson, University of Michigan
Timothy Jost, Washington and Lee University (organizer)
Theodore Joyce, CUNY
George A. Kaplan, University of Michigan
Jerome Karabel, University of California at Berkeley
Mark A.R.. Kleiman, UCLA
Paula M. Lantz, University of Michigan
Simon Lazarus, NSCLC
Arleen A. Leibowitz, UCLA
Theodore Marmor, Yale University
Lynda Martin-McCormick, NSCLC
Michael L. Millenson, Northwestern University.
James A. Morone, Brown University
Jonathan Oberlander, University of North Carolina at Chapel Hill
Karen Pollitz, Georgetown University
Harold Pollack, University of Chicago (organizer)
Daniel Polsky, University of Pennsylvania
Sara Rosenbaum, George Washington University
Meredith Rosenthal, Harvard University
Lainie Friedman Ross, University of Chicago
William Sage, University of Texas
Theda Skocpol, Harvard University
Paul Starr, Princeton University
William Terry, Brigham and Women’s Hospital
James A. Tulsky, Duke University
Alexander C. Wagenaar, University of Florida, Temple University
Joseph White, Case Western Reserve University
Celia Wcislo, 1199-United Healthcare Workers East, SEIU
(Institutional affiliations listed for identification only).
cc. Senator Harry Reid
President Barack Obama
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