The Health Insurance Reform Fight: A Progressive Scenario

The MSM commentators are now practically hysterical with joy. After months of giving a voice to the most ridiculous fictional stories about proposals for health care reform using the public option idea, they, along with the President’s incredibly inept messaging, have helped to move public opinion to the point where in some, though very misleading polls, more people oppose than favor a reform bill with a public option. So, now the President seems to be walking back his preference for it while telling everyone that his position is the same as it always was. This, of course, has stimulated a strong counter-reaction among progressives in Congress who are now saying that at least 60 and perhaps as many as 100 House progressives will not vote for a reform bill without a public option.

Meanwhile, the US Senate is falling all over its committee, seniority, and filibuster “peculiar institutions” to work itself into a position where it will refuse to pass any legislation with a public option. So, we have a deadlocked drama where the two houses of Congress are about to be locked in mortal combat with the future of health care reform hanging in the balance. Can Barack Obama, the great compromiser and exponent of harmonious bipartisanship, transcend the petty differences among the progressives and the Blue Dogs and arrive at a solution that both sides can happily accept? Will the great compromiser join one side or the other and help to beat the unlucky side down to move the bill forward? Will he beat both sides down and force them to accept a compromise that neither side wants? Or will he fail to move anyone and see health care legislation die a noisy death? Having set up the frame for this dramatic narrative, the MSM will be doing its best to fill it in during the next month or more, in the context of Town Halls, ad campaigns for and against the public option, and, of course, any weird and off the wall stories generated by right wingnuts and the commentariat that feeds off them symbiotically, and sometimes parasitically.

The question now is what should the progressives do to work through their part in the drama to transcend the play, and get a useful result for health care reform, that will fire the imagination of the MSM?

First, the progressives, and their organizations, and I mean HCAN, Move-on, CAP, and other progressive groups, need to STOP, STOP, STOP talking about the public option and start talking about “Medicare for All” as the only viable solution to health insurance reform in the American context. They need to do this every chance they get. In mailings, ads, at town halls, and in every venue they have, they need to educate and sell the concept of Medicare for All and NEVER, NEVER, NEVER talk about the public option.

If anyone asks them about the public option, they need to tell people to forget about it and that they were only talking about one earlier, because they thought it might be a way to achieve a compromise with the insurance industry and the Republican Party and others who weren’t comfortable with Medicare for All. Then they need to say that the Republicans, the insurance industry and some Democrats have shown that they are not interested in a compromise like the public option, so progressives have concluded that they may as well do their best to pass what they believe is the best solution to the health insurance reform problem, namely Medicare for All, and that until further notice, the public option is “off the table,” and progressives just aren’t interested in it anymore.

Second, progressives in Congress need to do the same thing, and also say that they will support only HR 676 or a variant of it, and will vote against every other legislative proposal for reform. Then they need to wait. When Nancy Pelosi comes calling and tells them that it won’t do to hang tough on HR 676, they need to tell her that HR 676 must pass the House, or there will be no health care reform; and they also need to tell her, that she needs to join up, and that if she won’t, there will be a new Speaker in the next Congress, whether the Republicans or Democrats win in 2010. Then she, the party line votes she commands, and the progressives need to steamroller HR 676 through the House, and then wait for the Conference, if something gets through the Senate at all.

In the Senate, progressive Democrats need to say the same thing as Democrats in the House about the PO, and about the current Senate HELP bill, and also need to tell people that they are now supporting Bernie Sanders’ S 703, a Medicare for All bill. They also need to emphasize that they insist that the role of the Senate Finance committee in all this must be restricted to financing health care alone, and that anything else that comes out of the finance committee will be rejected by them if it gets to the floor of the Senate and will not pass. When Harry Reid comes calling tell him that everything except S 703 is off the table for them, since their previous compromises have been rejected by the Blue Dogs and the Republicans, and that if they have to, they will filibuster against any other alternative reform bill including anything coming out of the finance committee. And again, also tell him that if he doesn’t join with them, and call the Blue Dogs on the carpet, there will be a new majority leader in the Senate in the next session, since they believe they can mobilize at least 40 Senate Democrats against him, and for either Dick Durbin or Chuck Schumer.

Undoubtedly, there will be considerable push back against progressives in the Senate for taking this position. For one thing the MSM will go off the wall at these progressive children kicking up their heels and throwing a tantrum. And certainly, Republicans will threaten to filibuster any S 703-like bill. However, if the Republicans filibuster, that filibuster can’t be broken without the support of the progressives backing S 703. So if the Blue Dogs and ConservaDems refuse to negotiate with the progressives, HCR goes down in the Senate. If the Blue Dogs propose a bill, that goes down to defeat without the progressives, because they can either defeat it with Republican support or, if the Republicans should join with the Blue Dogs, the progressives can still defeat it with a filibuster. So, any Blue Dog or middle of the road bill also goes down.

So, where are we at this point. It’s apparent that a bill would be needed that could compromise the progressive and Blue Dog positions. However, the situation would be different than it is now. The progressives are now backing a much simpler and more understandable bill than a PO bill like the Senate HELP committee bill, and S 703 also is a bill that they and their constituents can really believe in. Also, the House would already have passed HR 676. The Blue Dogs, of course, might still threaten to filibuster, but if they do that, what do they accomplish? The Medicare for All bill will be shown by CBO to be the least expensive of all the bills that have been considered up to that point, making it difficult for the Blue Dogs to object based on cost. They can object to socialized medicine, but the progressives can answer that Medicare is not socialized medicine, as every American knows who has used it. The Blue Dogs may then express their concern for the insurance industry, in which case they would have to bear the responsibility for defeating health care reform on grounds that the health insurance industry that kills 20,000 Americans per year through denial of access, and bankrupts one million others per year deserves to be defended by Senators who call themselves Democrats. I think that is a really bad message for Blue Dogs to take into the 2010 election, wherever they are running, and that their negotiating position would be much weaker in this scenario than it is now.

Of course, in the middle of this legislative process and the new progressive messaging, the President will continue to talk about the PO, as HR 676 gains traction in the House, the President will talk more and more about a PO being an acceptable compromise to him. In the Senate, as he sees the momentum shifting, he will start suggesting to the Blue Dogs that the best they’ll be able to get out of this is a strong public option bill. While this is going on, the progressives in the Senate, as well as progressive organizations should repeat the “Medicare for All” mantra to everyone who will listen. None should ever talk about a PO since that is now the President’s position that he will be trying to get the Blue Dogs to take, in return for his support in making it stick. If he succeeds, Progressives should stand firm on S 703 until they get a PO proposed to them by Obama and the Blue Dogs, which is as strong as that originally proposed by Jacob Hacker. Then and only then can they relent a bit on their position in order to get HCR through the Senate.

Now, of course, the bills must go to Conference. The House will go with HR 676 and the Senate with a strong PO bill. How, exactly things will work out we cannot say. But, of course, the MSM noise will be at a fever pitch, and the PO bill will still be harder to explain, will be longer (probably over 1,000 pages) and harder to read, and there will be lots of lies out there about it. HR 676 will be harder to lie about, though many will try, because it is only 30 pages in length. So what will win in the Conference? That depends very much on the President and his messaging, and also a good bit on the trend of public opinion at that time. If the progressive organizations and the House and Senate progressives have handled their messaging well, Medicare for All ought to be clearly understood and a popular choice. On the other hand, the Senate Blue Dogs may be able to persuade people that they need something for some of their constituents. Much depends, of course, on who Harry Reid appoints to the committee, so the progressives will have to insist that strong progressives be appointed to the Conference committee. Whichever bill passes the Conference in the end, however, the progressives will be much better off in the end game than they are today.

Of course, things may work out so that no bill comes out of the Senate and HCR goes down. In that case, progressives ought to introduce a back-up plan offered just yesterday by Scarecrow at Firedog Lake, based in part on an analysis of Dean Baker’s. I’ll provide my views on Scarecrow’s proposal in my next post.

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