Tuesday, January 05, 2010

Blaming The Senate

Ezra Klein of The Washington Post usually is a sane and sober analyst of health care reform. And in "After health care, we need Senate reform," he notes

The Democrats ended up focusing on health-care reform's low-hanging fruit: the bill the Senate ultimately passed does much more to increase coverage than it does to address the considerably harder problem of cost control, it strengthens the existing private insurance system and it does not include a public insurance option. And Democrats still could not find a single Republican vote, which meant they had to give Nebraska a coupon entitling it to a free Medicaid expansion and hand Joe Lieberman a voucher that's good for anything he wants. If the Senate cannot govern effectively even when history conspires to free its hand, then it cannot govern.

The Senate bill does: increase coverage more than it addresses the more complex problem of cost control; strengthen the existing private insurance system; and lack a public option. Moreover, Joe Lieberman and Ben Nelson have intimidated Democrats, ultimately controlling the process and, apparently, the eventual outcome.

But who are these "Democrats?" It was not Harry Reid's decision (video below) to endorse single-payer health care in 2003 (whether in June or December). Nor was it Harry Reid's decision to cede ground to the right. As in football, field position is critical. Kick the ball into the end zone and require the opposition to go 80 yards to score. Or deliberately kick the ball out-of-bounds, allowing the opposition to start its drive at the 40-yard-line. The Democratic Party could have proposed a single-payer system initially, forcing the GOP to push back and accept a robust public option Or it could have started by proposing a relatively weak public option, eventually taking solace in the hope that sometime, somehow, the bill could be improved. President Obama and his chief of staff chose the latter path and it has led to this.

Some elements of health care reform could not be approved without a sixty-vote majority. However, with only 50 votes (plus Vice-President Biden) necessary under reconciliation, expansion of Medicare and Medicaid, sufficiently increased revenue, and a government option could have been secured. Medicare would not need have been threatened, taxation of generous health insurance programs (many of them gained by collective bargaining) could have been averted, and there might have emerged real competition for the health insurance industry. But Rahm Emanuel, the power behind the throne, would not have been pleased.

The Byrd Rule prevents the Senate from passing non-budget items without at least 60 votes. Klein identifies "a coming budget crisis, catastrophic climate change and an archaic and inefficient tax system" as among "a few" other problems which won't "be solved until we fix the dysfunctions of the Senate."

Here is one other "problem," as the wealthy and well-connected see it: the rising cost of entitlement programs. "Fix" the Senate, get a 51-vote Republican majority in the Senate (or 50 plus a GOP president), and watch them go to work against programs which help the elderly. Means-test Medicare? No problem. Privatize Social Security, enriching Wall Street at the expense of older Americans? No problem.

As Drew Westen implies, President Obama's strategy has been to "Let Congress work it out, and whatever comes out, call it a victory." And then, evidently, sit back and watch the pundits blame Congress for the failure to secure effective health care reform.

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