U.S. Senate Democrats collapsed across the finish line this
week, scoring an uncertain victory in the early morning hours of Monday
with legislation that fell far short of the “affordable,
comprehensive healthcare” promised by the party in the 2008
election.
In an email message to Nevadans, Senate Democratic leader Harry Reid
of Nevada said the measure will “rein in costs even further, make
care more affordable by expanding small business tax credits, demand
even greater accountability from insurance companies, create more
choice and competition for consumers.”
The legislation teed up for passage when Democrats voted to end
debate and move on to voting was like the elephant in the tale about
the group of blind men—everyone who touched it described a
different beast. Some described it as, if not the comprehensive plan
promised, still a huge step ahead in protecting the public.
Others—and they included both liberal Democrats and conservative
Republicans—found innumerable faults in the bill.
In an editorial headlined “Change Nobody Believes In,”
the Wall Street Journal called the measure “a bill so reckless
that it has to be rammed through on a partisan vote on Christmas
eve.” In an election, a 60 percent majority is a landslide, but
the Journal called 60 out of a hundred votes in the Senate a
“narrow majority.”
Yale political scientist Jacob Hacker, who wrote a book on health
care reform and said he was “devastated” when the public
option plan “was killed at the hands of Senator Joe
Lieberman,” wrote in the New Republic that passage of the
Democratic bill was still essential: “The lack of a public option
also makes even more imperative tough requirements on insurers to make
them live up to their stated commitment to change their business model
and slow the spiraling cost of coverage.”
Immediately after the Democrats voted to end debate and move on to
voting on the bill, Time magazine asked if Sen. Reid had made the
battle tougher than it had to be and concluded he had not: “Reid,
says [former Democratic leader Tom] Daschle, had no choice but to
[initially] offer the public option. ‘He was under intense
pressure from the House [which has one in its bill] and the liberals in
the caucus to at least make the effort.’ Also, by including the
option, Reid gained a valuable bargaining chip—something he could
give up in negotiations to win the votes of more conservative members
like Connecticut’s Joe Lieberman, an independent who is counted
as part of the Democratic caucus, and Nebraska’s Ben
Nelson.”
That still leaves the question of whether the bill that emerged at
the end was worth the effort. In last year’s election, the public
stuffed substantial resources into one end of the pipeline—a
Democratic president and a huge Democratic majority. What came out the
other end of the pipeline this week was a trickle compared to the
program Obama and the party had promised. Moreover, if the Democrats
cannot accomplish a national health insurance program now, it will
probably not do so in this generation—how often does a political
party have the advantages the Democrats enjoy this year?
On Dec. 8, Senate Democrats ended their effort to pass a bill
containing a public option in favor of a proposal allowing 55-year-olds
without coverage to buy into Medicare. Then on Dec. 14 the Medicare
proposal was similarly dropped to appease the blue dog Democrats.
Either measure had 51 votes to pass the Senate, but Democrats were
unwilling to return majority rule to the Senate by dropping an arcane
procedure requiring 60-vote majorities to end imaginary
filibusters.
Under the imaginary filibuster system, a single senator in the
60-senator Democratic majority enjoyed a veto over the bill, and
several Democrats used—or abused—that leverage to deny the
majority a chance to vote for a bill reflecting majority sentiment. In
effect, Nelson and Lieberman used their single votes to defeat bills
that most of their colleagues wanted to enact.
The loss of both the public option and the Medicare substitute
infuriated regular Democrats. Former Vermont governor Howard Dean, a
physician, told a public radio station in his home state, “This
is essentially the collapse of healthcare reform in the United States
Senate. And, honestly, the best thing to do right now is kill the
Senate bill. … There are some good things in this bill, but
they’re small.” Dean, as Democratic national chair, was an
architect last year of the party’s national electoral
victory.
The AFL/CIO and the Service Employees International Union, strong
Democratic supporters, declined to support the Democratic bill.
But Ohio Democratic Sen. Sherrod Brown reluctantly stuck with the
new bill, saying the issue should not be individual senators.
“And it’s not [about] me, it’s not about any senator,
it’s not about Lieberman, it’s not about Harry
Reid.”
Cost containment
Massachusetts Institute of Technology economist Jonathan Gruber has
tracked the cost containment provisions of the ever changing Democratic
measure all along. He was one of a couple of dozen economists who sent
a letter to President Obama insisting that “deficit
neutrality” had to be one of four essential elements to any
health-reform bill. He has previously told reporters he was skeptical
that cost containment will be one of the outcomes of the health reform
fight.
Last weekend, Gruber told the News & Review that the new Reid
measure retains and improves the cost containment provisions that were
already strong in the previous bill: “Cost containment is in fact
improved in this version. Most importantly, the independent board that
can make recommendations on payment reform now has tighter
targets—and can recommend changes for both Medicare and the
private sector. This bill goes much farther on cost control than I, for
one, thought was politically possible in today’s
environment.”
Republicans who stayed out of the debate over health care except to
criticize Democratic efforts undertook some half-hearted efforts at the
end to stop the bill. They tried unsuccessfully to hold up military
spending—including troop funding—to keep the Senate from
moving on to the health care issue. They invoked a rule requiring that
an amendment “be read aloud.” But the GOP effort at a
“read-a-thon” became less of an obstacle when Independent
Sen. Bernie Sanders of Vermont withdrew his own 767-page amendment
(creating a national single-payer health care system) in order to stop
the Republican stall and let voting begin. That still left the reading
of the 383-page amendment introduced by Reid on Saturday, which was
read aloud by clerks starting at mid-morning Saturday and ending at
exactly 4 p.m.
The final version of the bill, estimated to cost $871 billion over
the next 10 years, contained new language on abortion (allowing states
to opt out of abortion coverage) and Nebraska-related goodies to give
blue dog Nelson a reason to provide Reid with what the New York Times
called “the handshake of a lifetime.”
After Reid obtained that 60th vote, the National Republican
Senatorial Committee put out a statement saying that “polling
data among Nevada voters continues to show Reid’s constituents
are strongly opposed to the legislation on which the Majority Leader
has seemingly staked his reelection.” The committee cited a Las
Vegas Review-Journal poll to support its claim. However, that survey
was taken two Democratic healthcare plans ago, when the Senate was
still debating Reid’s public option plan.
Gruber said that Reid “has truly been a hero on this
issue—especially given that he faces reelection this year.