The President made his eleventh-hour call for comprehensive health care reform on Wednesday, challenging Congress to have an up or down vote within weeks. Once again, he embraced a spirit of bipartisanship that will not likely yield a single Republican vote. But he also articulated a sense of urgency, and appropriately so, that time is up and Congress must take action now.
His speech comes on the heels of a letter to Congress, in which he said that he would incorporate Republican ideas into the bill, including: 1) engaging “medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs”; 2) $50 million to states for alternatives to resolving medical malpractice disputes, such as health courts; 3) additional funds for Medicaid reimbursements to doctors, and 4) an expansion of Health Savings Accounts (HSAs).
As a part of his last-minute push, President Obama plans to take health care on the road, with town hall events scheduled next week in Philadelphia and St. Louis.
On one level, President Obama chose a rhetorical middle ground, which was consistent with his self-appointed role as a bridge builder. “On one end of the spectrum, there are some who’ve suggested scrapping our system of private insurance and replacing it with a government-run health care system. And though many other countries have such a system, in America it would be neither practical nor realistic,” the president said. At the same time, he rejected the position of many congressional Republicans that government should loosen regulations on the insurance industry. “The argument is, is that that will somehow lower costs. I disagree with that approach,” he said. “I’m concerned that this would only give the insurance industry even freer rein to raise premiums and deny care.”
President Obama laid out a $100 billion-a-year proposal that he said would give consumers more control over their insurance, and hold insurance companies more accountable. He argued that his proposal will change three things about the present system: 1) End the worst practices of insurance companies, including denying of coverage based on a preexisting condition, dropping coverage because of an illness, and random, massive rate hikes; 2) Give uninsured individuals and small businesses the same insurance choices that members of Congress enjoy, and 3) Provide tax credits to those who cannot afford insurance.
Obama hinted he is open to Congress passing legislation through the reconciliation process. Missing from Obama’s address was any mention of a public health insurance option, which enjoys majority support throughout the nation, and is more popular than the Senate plan, according to recent polls. Meanwhile, three more senators have signed onto a letter calling for Senate majority leader Harry Reid (D-Nevada) to pass a public option through reconciliation. The special procedure used for budgetary items would require a mere 51-vote majority for passage, as opposed to a filibuster-proof supermajority of 60 votes.
There is a strong argument in favor of reconciliation. Evoking memories of segregationist Dixiecrats’ attempts to block civil rights legislation in the 1960s, and then some, the Republican minority’s voracious appetite for the filibuster has brought business in that legislative body to a standstill of late. With individual lawmakers able to hold up votes on crucial bills—blocking everything from the extension of unemployment benefits to votes on nominees to cabinet posts—the Senate looks increasingly like a paralyzed, dysfunctional body.
So, the President is hedging on the public option. His willingness to drop the public option has angered the Obama base, reflecting more of a Rahm Emanuel-inspired, Washington-insider move, rather than the convictions of the bold campaigner and change agent of 2008. Nevertheless, he did leave it to Congress to get the job done in the next few weeks, and it is up to them to access the public option route, should they choose to do so.
Despite his seemingly quixotic quest for bipartisanship, President Obama apparently understands its limits. He laid a trap for Republicans should health care succeed and they refuse to vote for it. “Even those who acknowledge the problem of the uninsured say we just can’t afford to help them right now —- which is why the Republican proposal only covers 3 million uninsured Americans while we cover over 31 million,” he said of his GOP adversaries.
Obama also acknowledged that although he has incorporated many Republican ideas in his plan, Republicans fundamentally disagree with him over insurance regulation. “And if they truly believe that less regulation would lead to higher quality, more affordable health insurance, then they should vote against the proposal I’ve put forward,” he said.
Further, the President persuasively argued against the piecemeal approach to solving health care, on the grounds that reforms depend on everyone having access to coverage. And to those Republican critics who suggest that they start the whole process over from scratch, Obama concluded that “given these honest and substantial differences between the parties… I don’t see how another year of negotiations would help.”
Ultimately, President Obama made the pursuit of reform a moral issue. He spoke of the people who would be saved by insurance reform, including a woman with breast cancer whose company would finally have to pay for her chemotherapy. And he spoke of a woman with cancer who has insurance today, yet whose family is so saddled with debt due to medical bills that she cannot focus on getting well. “This should not happen in the United States of America. And it doesn’t have to,” the President said. “It’s about what kind of country we want to be. It’s about the millions of lives that would be touched and, in some cases, saved by making private health insurance more secure and more affordable.”
As President Obama aptly noted, the health care debate has been a “long and wrenching” one, easily susceptible to “demagoguery and political gamesmanship, and misrepresentation and misunderstanding.” And he was correct to say that people are waiting for them to act and to lead, that what is “at stake right now is not just our ability to solve this problem, but our ability to solve any problem. The American people want to know if it’s still possible for Washington to look out for their interests and their future.”
Indeed, the road has been long, with, arguably, an administration that was too lackadaisical at first, too unwilling to grow a backbone and take a stand on its own health care reform platform. Fixated on the process rather than the product, the administration deferred to Congress and allowed too much time to pass. The White House lost control over the message. Republican obstructionism and Tea Party foolishness ensued. Democrats started negotiating with themselves and lost. The public saw too much of the sausage making in Congress, and decided it did not like sausage. But the people still liked the public option, and its absence in the final bill certainly would be a harbinger of low Democratic turnout in the 2010 midterm elections.
President Obama has come closer than any president in accomplishing comprehensive healthcare reform, yet he has much more work to do to get his Democratic soldiers in line. There is much promise, though I would never underestimate the ability of Democrats to snatch defeat from the jaws of victory. As the party with control of the White House and majorities in both chambers of Congress, health care reform was supposed to be a slam dunk. But there is still time to do this.