Pass the health care reform bill to keep the process moving forward

Posted by AzBlueMeanie:

Americans hate stories about process. They are not taught about the legislative process and what little they learned years ago from Schoolhouse Rock- How a Bill Becomes a Law is simplistic and inaccurate today. It is probably a safe bet to say that 99% of Americans don't understand the legislative process – and they don't care to know.

We live in an age of instant gratification. "I know what I want and I want it now!" is the American credo. You might say this is an infantile response to wants and needs. This can lead to manic-depressive mood swings in the electorate. If Americans get what they want, approval ratings go up. If they have to wait for what they want, or worse yet, they don't get everything they want, approval ratings go down.

The schism that has developed within the Democratic Party is not between "liberals" and "conservatives" per se, but rather between incrementalists and idealists.

On Inauguration Day, the idealists were euphoric: they had elected a president who promised change from the radically regressive Bush-Cheney regime and who could inspire a new generation of Americans to public service like John F. Kennedy. Many in the media wrote stories about the expectations of Americans that Barack Obama would be a new FDR and bring about A New New Deal – Obama's Agenda: Get America Back on Track This ramping up of expectations by the media was inaccurate before the stories were ever written.

Obama had already selected Rahm Emanuel as his White House Chief of Staff, Hillary Clinton as his Secretary of State, and populated his administration with former "Clintonistas" who had served in the Clinton administration. The "new progressive era" being touted by the media was belied by Obama's appointments to key positions in his administration. These were Democratic Leadership Council (DLC), New Democrats, Third Way, pro-corporate center-right Democrats who had enabled the Republicans to realize their political agenda from 1994 to 2008 through "bipartisanship." The progressive's sense that they have been played by Obama during the campaign and have been betrayed is palpable. Obama talked the talk of progressives during the campaign but he has not walked the walk as president.

The euphoric high of the idealists on Inauguration Day has crashed into a deep funk of depression in this winter of their discontent as they have come to realize that Barack Obama is not interested in becoming a new FDR, but rather a continuation of the Clinton administration. They voted for Obama and got Clinton anyway. Obama's declining poll numbers are largely due to the loss of support from among the progressive base of the Democratic Party and like-minded independents who voted for progressive change. It is not that Obama is attempting to do too much, as the conventional wisdom of the Beltway bloviators falsely assert, but rather that he has done too little to advance the progressive cause.

The idealists are angry and depressed that Obama did not immediately reverse all of the regressive policies of the Bush-Cheney regime and hold accountable those responsible for these often unconstitutional and illegal policies. The idealists are angry and depressed that Obama did not immediately move to reverse the "casino capitalism" on Wall Street and hold accountable those responsible for nearly destroying our financial system and our economy.

And the idealists are angry and depressed that Obama over-sold and under-performed on his signature legislative issue: health care reform. The idealists had unrealistically high expectations on this issue. They saw this as an historical opportunity to achieve the goal of Presidents Theodore Roosevelt and Harry Truman by finally enacting landmark legislation for a national health care system that provides universal coverage for all Americans.

But landmark legislation is only possible when an issue has ripened to a national consensus that it is a problem which must be addressed. The Civil Rights Movement provides an historical context. Congress enacted a series of civil rights acts in the post-Civil War era and the post-World War II era. But these incremental changes (often not enforced) proved ineffective in combating the fundamental deprivation of civil rights of American citizens in a race-segregated society. The Civil Rights Movement focused national attention on this issue until it ripened to a national consensus that this was a problem which must be addressed. The result was landmark legislation, the Civil Rights Act of 1964, the Voting Rights Act of 1965, and adoption of the 24th Amendment prohibiting the poll tax.

While the cost of health care is an issue for all Americans, the lack of health care insurance is an issue only for those who do not have health insurance coverage. While some have tried to characterize this issue as the civil rights issue of our day, this movement is still in its infancy and has not advanced to the stage of a public consensus. As the debate over the health care reform bill has demonstrated, there is no national consensus on the way forward. Options range from the single-payer "Medicare for all" to Sen. Kent Conrad's private health insurance co-op plan, to the private health insurance exchanges emerging from Congress.

The health care reform bill has run into the legislative process of the Senate where the incrementalists live. It is the "sausage making" process that Americans do not understand and do not care to know about.

The incrementalist approach is best explained by Sen. Tom Harkin (D-IA) – who happens to be a classical liberal Democrat and supporter of expanded Medicare and a public option by the way. As Sen. Harkin explains it Think of health care reform as a starter home:

“What we are buying here is a modest home, not a mansion. What we are getting here is a starter home. It’s got a good foundation: 30 million Americans are covered. It’s got a good roof: A lot of protections from abuses by insurance companies. It’s got a lot of nice stuff in there for prevention and wellness. But, we can build additions as we go along in the future. It is a starter home. Think about it in that way.”

Sen. Harkin shares the frustrations of Doctor Howard Dean on the watering down of the health care reform bill in the Senate by the likes of Sen. Traitor Joe Lieberman (The party of me!-CT) who represents "the insurance capitol of the world," and Sen. Ben Nelson (D-NE), the senator from Mutual of Omaha Insurance Company and a former insurance company executive and regulator. Many of the criticisms of Howard Dean in his recent Washington Post opinion are legitimate Health-care bill wouldn't bring real reform, and should serve as the basis for amendments in the joint House-Senate conference committee markup of a final bill (the point Dean is making), or for future legislation to make improvements to this "starter home."

“I think [Dean] is speaking to the frustration of many of the progressives in this country who recognize what I think is sort of the common sense approach of having at least one public option out there,” Harkin said.

“I think there is a lot of frustration out there — I have it myself. But you can’t let frustration turn into defeat.”

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One of key reasons Harkin, who has pushed repeatedly for a robust public option, continues to support the bill is for the prevention and wellness provisions it contains.

“The medical community, the public health community and others interested in wellness realize that it is a big deal to get this in the bill. We lose all of that if we go to reconciliation — all of the insurance reforms on pre-existing conditions, and no lifetime caps, and no gender discrimination — we lose all of that,” Harkin said.

Although Dean believes that such provisions can be recaptured later, through subsequent amendments and modifications of a final health reform bill with a public option, Harkin is adamant that the changes must be made now.

“I told [Dean] that we have trouble passing a resolution saying there are seven days in the week,” he said, labeling the current Republican policy of using as much floor time as possible on every bill as “scorched earth.”

“What are we up to, 90 filibusters now? It means it has gotten to the point where everything has to be filibustered — everything…

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Yet if the “starter home” version of health care reform can be approved, Harkin remains confident that it will ultimately be the demands of the people that result in changes, additions and enhancements.

“Once you break the [special interest] stranglehold and you get the architecture in place, then it is not a massive reform to change this or add this or modify that,” he said. “My hope is that we move ahead on this and as reforms are in place, people will begin to say, ‘Gee, I didn’t realize that was what they were talking about.’ As more and more of these reforms take place, people will say that this is good, but we need something else, to change this or do that.

“In the future, amending it and changing it isn’t going to be as tough as passing it in the first place. We amend Medicare and Social Security all the time. We are changing rates, fixing this, doing this to make sure that they are viable. That’s what we will do in health care. I’m absolutely convinced of it.”

And there is one other thing Harkin is convinced will eventually come to pass: A public option.

“At some point in the near future, and I don’t know exactly how long it is going to be, we are going to have some sort of a public option out there,” he said. “We might not get it in this bill, but it will come in as the years go by and as people begin to look at insurance companies and how much they are charging. I have no doubt in my mind that we are going to have to go to some kind of a public option, some type of a single-payer type system to bring the costs down.

Nobel Prize economist and New York Times columnist Paul Krugman has been highly critical of the health care reform bill emerging in Congress, but he too recognizes the urgency of laying the foundation for future legislation in this "starter home" bill. Pass the Bill:

A message to progressives: By all means, hang Senator Joe Lieberman in effigy. Declare that you’re disappointed in and/or disgusted with President Obama. Demand a change in Senate rules that, combined with the Republican strategy of total obstructionism, are in the process of making America ungovernable.

But meanwhile, pass the health care bill.

Yes, the filibuster-imposed need to get votes from “centrist” senators has led to a bill that falls a long way short of ideal. Worse, some of those senators seem motivated largely by a desire to protect the interests of insurance companies — with the possible exception of Mr. Lieberman, who seems motivated by sheer spite.

But let’s all take a deep breath, and consider just how much good this bill would do, if passed — and how much better it would be than anything that seemed possible just a few years ago. With all its flaws, the Senate health bill would be the biggest expansion of the social safety net since Medicare, greatly improving the lives of millions. Getting this bill would be much, much better than watching health care reform fail.

At its core, the bill would do two things. First, it would prohibit discrimination by insurance companies on the basis of medical condition or history: Americans could no longer be denied health insurance because of a pre-existing condition, or have their insurance canceled when they get sick. Second, the bill would provide substantial financial aid to those who don’t get insurance through their employers, as well as tax breaks for small employers that do provide insurance.

All of this would be paid for in large part with the first serious effort ever to rein in rising health care costs.

The result would be a huge increase in the availability and affordability of health insurance, with more than 30 million Americans gaining coverage, and premiums for lower-income and lower-middle-income Americans falling dramatically.

Krugman also makes an important historical point that social security and medicare did not start out as the programs we know today. They also were "starter homes":

Bear in mind also the lessons of history: social insurance programs tend to start out highly imperfect and incomplete, but get better and more comprehensive as the years go by. Thus Social Security originally had huge gaps in coverage — and a majority of African-Americans, in particular, fell through those gaps. But it was improved over time, and it’s now the bedrock of retirement stability for the vast majority of Americans.

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The question, then, is whether to pay the ransom by giving in to the demands of those senators, accepting a flawed bill, or hang tough and let the hostage — that is, health reform — die.

Again, history suggests the answer. Whereas flawed social insurance programs have tended to get better over time, the story of health reform suggests that rejecting an imperfect deal in the hope of eventually getting something better is a recipe for getting nothing at all. Not to put too fine a point on it, America would be in much better shape today if Democrats had cut a deal on health care with Richard Nixon, or if Bill Clinton had cut a deal with moderate Republicans back when they still existed.

On this point, the widow of Senator Ted Kennedy, Victoria Kennedy, opines that the "Liberal Lion of the Senate" learned his lesson from his failure to craft a deal with Richard Nixon and he would accept the deal on the table today. Victoria Reggie Kennedy – The moment Ted Kennedy would not want to lose:

[Ted] predicted that as the Senate got closer to a vote, compromises would be necessary, coalitions would falter and many ardent supporters of reform would want to walk away. He hoped that they wouldn't do so. He knew from experience, he told me, that this kind of opportunity to enact health-care reform wouldn't arise again for a generation.

In the early 1970s, Ted worked with the Nixon administration to find consensus on health-care reform. Those efforts broke down in part because the compromise wasn't ideologically pure enough for some constituency groups. More than 20 years passed before there was another real opportunity for reform, years during which human suffering only increased. Even with the committed leadership of then-President Bill Clinton and his wife, reform was thwarted in the 1990s. As Ted wrote in his memoir, he was deeply disappointed that the Clinton health-care bill did not come to a vote in the full Senate.

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Ted often said that we can't let the perfect be the enemy of the good. He also said that it was better to get half a loaf than no loaf at all, especially with so many lives at stake. That's why, even as he never stopped fighting for comprehensive health-care reform, he also championed incremental but effective reforms such as a Patients' Bill of Rights, the Children's Health Insurance Program and COBRA continuation of health coverage.

The bill before the Senate, while imperfect, would achieve many of the goals Ted fought for during the 40 years he championed access to quality, affordable health care for all Americans.

* * *

While my husband believed in a robust public option as an effective way to lower costs and increase competition, he also believed in not losing sight of the forest for the trees. As long as he wasn't compromising his principles or values, he looked for a way forward.

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[Ted's] not here to urge us not to let this chance slip through our fingers. So I humbly ask his colleagues to finish the work of his life, the work of generations, to allow the vote to go forward and to pass health-care reform now. As Ted always said, when it's finally done, the people will wonder what took so long.

On Saturday, Democrats reportedly secured the 60 votes necessary under Senate rules for cloture to end debate. Updated: Senate Democrats Clinch a Deal on Health Bill Due to the abusive dilatory tactics of Republicans who are opposed to any and all reforms to the health care system, the cloture vote is expected to occur early Monday morning. If the cloture vote is successful, the Senate health care reform bill may be voted upon on Christmas Eve.

Passage of the Senate bill will allow the process to move forward to the joint House-Senate conference committee where it is still possible to make improvements to the final bill to be voted upon by Congress. It will not be the mansion that idealists had hoped for, but it will be a "starter home" with a solid foundation on which to build additions in future years. It helps to take a long view of history, and to not give in to our modern culture of instant gratification.

To paraphrase coach Bum Phillips of the Houston Oilers in 1979: “One year ago, we knocked on the door. This year, we beat on the door. Next year, we’re going to kick the son-of-a-bitch in.” Take this incremental advance in health care reform and run on making improvements to it in the 2010 election.

Run against the obstructionists who stood in the way of long-necessary reform of our health care system. The Democrats who stood in the way should face a primary challenger; elect better Democrats. The Republicans who stood in the way and who have disgraced themselves with abusive dilatory tactics motivated by partisanship and a desire to serve their corporate benefactors should be rejected by the American electorate. The Party of No has forfeited any claim to legitimacy, and has nothing to offer.