Posted by rflacks on:
I'm getting more and more worried about the healthcare reform. Politically, Obama has to have a bill passed. For some reason, the Baucus bill is the center of media attention; allegedly this is the foundation for what the final bill will look like. The progressive reform coalition has been stressing the public option as the line in the sand, and that's not in the Baucus version. Less attention has been focused on the fact that the Baucus bill falls far short of universal health care. So by 10 years from now this measure will enable coverage for 94% of the population. The percentage sounds pretty good-until you pause to realize that 20 million people won't be covered...even ten years from now. Indeed, most of the bill's provisions won't go into effect for another four years.
I have been hoping that the US would have universal healthcare before I die. The year I was born was when healthcare was chopped out of social security; the plan was to introduce it later so that old age insurance could get passed. In 1948, at age 10, we debated ‘socialized medicine' in my sixth grade class. It was a hot topic sixty years ago. About 20 years later, LBJ achieved Medicare-and again the notion was that this would provide the wedge for universality soon. Then came the Clinton debacle-more than 15 years ago. Now we face the prospect of a healthcare ‘reform' that will postpone universality again.
Not only is the Baucus bill not universal; it isn't clear that it will lower health costs for average citizens. Will the subsidies it provides enable the uninsured to afford insurance? We haven't been told.
Baucus wants to pay for subsidies largely by taxing ‘cadillac' insurance plans. In short, his bill wants to reduce the quality of health care for large numbers of unionized workers by encouraging the insurance companies to lower premiums. In fact, the big reform the Baucus crowd is after is to hold down the social cost of healthcare. The total cost of the reform package is pegged at 900 billion over the next decade. Achieving that estimate seems to be the primary obsession of the Baucusians and the Obama administration. A trillion, they seem to have decided, would sound too big for the ‘public'.
We're told that LBJ absolutely refused to allow long-term cost estimates when Medicare was being considered in congress. Any long-term cost estimate, he realized, would sound like too much. Medicare was designed to provide every senior citizen with adequate medical coverage. Baucus care is not about adequate coverage for all.
The house bills have gotten almost no attention, but they embody the progressive position in the current struggle. That's largely because of the tough stand taken by the progressive caucus and its allies who have vowed to vote against a bill that lacks the public option and related measures.
There are three big stages coming up as we move toward a conclusion of the struggle. The Baucus bill has to be mashed up with the Senate health committee's version. Today's LA Times reports that the chair of that committee, Chris Dodd, has bought into the Baucus goal of limiting total costs. He's claiming to be Teddy Kennedy's heir on this issue. Somehow one imagines however that Teddy at this point would be demanding that the goal ought to be health care for all, rather than cost containment. Of course Senator Dodd is a practiced representative of the insurance industry, so his perspective may be a bit different. Anyway, a bill will be mashed up, and then the big media drama about how the 60 votes for cloture will be achieved will be played out. We'll be praying for those votes for a bill that is going to be hard to stomach. Indeed, a number of those who will vote for cloture won't vote for the final bill, but will hold it hostage so it will be as weak as possible.
If the House manages to pass a reasonably progressive bill, with a public option that actually might work as an alternative to for-profit insurance, and with subsidies that might actually help people afford insurance, and with the hope of universal coverage, a truly monumental drama might then ensue. It's at that point that the chance for a progressive breakthrough might be possible.
As far as I can tell, that outcome absolutely depends on the HCAN coalition--the national force for progressive reform. I can't see how the breakthrough can happen without strong mobilization at the grassroots. Not just getting folks to keep emailing congress persons, but visible movement in the streets. The targeting of insurance company offices a few weeks ago may have had some effect. The public option was said to be dead by the mainstream media -but that turned out to quite wrong----and its possible that the demonstrations helped strengthen the progressive caucus. There's clearly been a shift even in senate rhetoric toward the ‘public option (though what it will consist of is very murky).
Too many on the left are wringing their hands at the failures of Obama to lead progressive reform. The late night TV jokes are all about his failures to deliver. But all the experienced organizers in the unions and the citizen action groups know very well that the president will only be able to lead in the right direction if he can respond to movement that demands that direction. What I'm fearing is that the progressive leadership is buying the argument that any bill is better than none, that the ‘perfect can't be the enemy of the good', that we should pass something -anything-now and fight again another day. We may however end up with a health reform that the people will experience as a flop. They will be forced to buy insurance, but their costs will still go up and their coverage down. That scenario will end the progressive movement. And the acceptance of weak compromise without a real fight will have a really demoralizing effect on the all of us who have swallowed the stupidity of abandoning ‘single payer' in the hope of at least something of value. I hope our leaders in Washington -in the government and in the national organizations are giving deep thought to such concerns.