Friday, February 26, 2010

Elephants in the Summit Room: Gland Old Party Offers 10% Solution and 1% Wallop

I subjected myself to watching almost all of yesterday's seven-hour health summit, except for about 90 minutes after the lunch break, when I had to attend some continuing professional education on the internet.

In the view of some commentators, that puts me in not very savory company: presidential historian Douglas Brinkley, who's also a professor at Houston's Rice University, thinks "Only the infirm or unemployed could have possibly sat home and watched it all."

Actually, the live audience was probably a bit larger than that. I, for example, am retired but not yet on Medicare; so I have time to monitor the progress (if any) of political and religious change I consider important. As a retired federal employee, progress on health care reform is near the very top of my list. And, by the way, I watched the first three hours of the summit in a library, with my laptop on WiFi, with earphones.

I hope Brinkley and other commentators are wrong, when they dismiss the summit as only a stunt and a spectacle. Granted, a chief aim of the proceedings was to give the Democrats cover on the issue of bipartisan cooperation. But the Republicans did such a wonderful job of demonstrating why they will never cooperate.

There were elephants plopping in the conference room every hour--stubborn Republican talking points, usually bereft of fact, that made President Obama's point for him: the tired white male conservatives of the Gland Old Party have no intention of ever supporting real health care reform, no matter how many of their alternatives the Democrats include. Their constituents require them to block any health care reform at all, and once again they make securing their base more important than the welfare of the United States.

I never heard anyone in the room say it. But the biggest elephant in the room was in the contrast between the number of uninsured whom the Congressional Budget Office (CBO) says would get insurance under the parties' very different health plans: roughly 30 million under the Democratic bills, and 3 million under a bill introduced by House Minority Leader John Boehner.

So compared to the Democrats, the Republican view of 'real' health reform is a 10% solution: their philosophy and their constituents will only allow them to achieve reducing the ranks of 47 million uninsured nationally by 3 million people.

Could any proposal be more transparently cynical? Is it any wonder that Boehner's bill takes up only 10% as many pages as the Democratic measure? The Republicans think a 10% solution will change something. Right. It will make the health care situation worse. As Obama and others observed, baby steps won't cut it; they will make the problem that much harder to fix.

Actually, the achievement is even more paltry. If 47 million is roughly the accurate number of Americans without health insurance, the Democrats would be addressing 64% of the problem. Helping only 3 million, the Republicans would be addressing less than 1%. Leaving 36% still uninsured is unacceptable. Leaving 99% still uninsured is criminal.

A second large elephant was John McCain.

First, the Republicans put the Democrats in the position where they must have 60 Senate votes for cloture. The Republicans know that has two include two Independents who sometimes vote with the Democrats, and several centrist Democrats from conservative states who will soon face very tight races with Republicans. So this gives all 60 senators who favor the legislation an individual veto power over its contents. Some of the more greedy use their veto power to secure unseemly deals for their states. Senate Majority Leader Harry Reid, doing his best to emulate Lyndon Johnson in his hey day, makes the deals necessary to get their votes. And along comes John McCain to regurgitate his campaign slogan, "This is not change we can believe in."

Please. Yes, it's politics as usual. But frankly the Republicans knew damn well that the bill's proponents would have to play politics as usual, because the Republicans insisted in running their Senate caucus like a Borg cube and ruthlessly casting their 40 votes in lockstep.

So McCain, as the liberal Jesuits used to say of their conservative colleagues when I was in college, takes off the old man and puts on . . . the old woman! He whines about an outcome he and his colleagues did their damnedest to ensure. How genuine.

A third large elephant was the absolute evil of high-risk pools.

The Democrats did an excellent job demonstrating how the insurance companies create the health-care equivalent of leper colonies--ostracizing the terminally ill, the chronically ill and anyone whose condition costs big bucks to treat into pools with no one else. The pool gets no income from the young, the healthy or those with complaints that can be treated cheaply. As a result, the pool and its insured play out a death spiral where the income stagnates, the costs rise dramatically, and eventually the policy-owners become unable to pay.

The Democrats aim to abolish such pools and ensure that any insurance pool have a productive mix of healthy and sick, young and old, rich and poor--all with minimum coverage standards that would apply in every state. The Republicans favor the status quo. Shame on them.

The final large elephant was the Republican dismay at the legislative process.

They professed horror that if they failed to get their way--i.e., have the Democrats shelve their bills and "start over," so that the Republicans could demonize their contents for several more months--the Democrats would resort to passing the bill as several budget reconciliation measures, a rare and radical tactic, heaven forfend.

An excellent article in the New York Times February 24th shows that since the reconciliation procedure was adopted in a 1974 budget law--during the last year of Richard Nixon's presidency and with the Democrats in control of Congress--reconciliation bills have made it through Congress 22 times. Of those acts, 16 were passed when Republicans were the majority party.

The first use of reconciliation to enact major legislation was to pass a package of spending cuts to offset President Ronald Reagan's tax cuts. Among other Republican uses of reconciliation acts, the article cites: "the signature tax cuts of President George W. Bush, the 1996 overhaul of the welfare system, the Children’s Health Insurance Program, Medicare Advantage insurance policies and the Cobra program allowing people who leave a job to pay to keep the health coverage their employer provided (the 'R' and 'A' in Cobra stand for 'reconciliation act'). "

So for the Republicans to cry foul over a Democratic threat to pass health care reform by reconciliation is about as disingenuous as it gets. Again, it is politics as usual and again it is Republicans who are resorting to it first.

Hopefully one way or another--through live viewing or sound bites or fact-checking or more thoughtful analysis--enough voters will get the point: the Republicans are intent on obstructing the health reform Americans want.

That's Obama's best hope, either for embarrassing a few Republicans who can no longer abide the comic chutzpah of their peers, or failing that, for using reconciliation and convincing the voters that the legislation was well worth saving and the Republicans gave them no other choice.

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