Time for ‘Chicago Way’

The House finally passed a compromise health-care reform bill on a 220-215 vote Saturday night, Nov. 7. We call it a compromise because progressive Democrats had to give up on the most comprehensive reforms — first, expansion of Medicare to cover all Americans, then the fallback of a robust government-run public option that any business or individual could buy into — in favor of a hybrid plan that would subsidize private insurance but insist on national standards for coverage.

House Speaker Nancy Pelosi had promised single-payer advocates that they would get a floor vote on their alternative bill to expand Medicare to cover everybody, but she reneged on that promise and convinced Rep. Anthony Weiner (D-N.Y.) to withdraw the Medicare-for-All amendment. She also stripped from the bill, HR 3962, a provision authored by Rep. Dennis Kucinich (D-Ohio) that would allow states to enact their own single-payer insurance plans — which are now banned by federal law.

In her defense, Pelosi could afford to lose up to 40 Dems and still prevail — and she ended up losing 39. While most were conservative “Blue Dogs,” they also included Kucinich, who said, “instead of working toward the elimination of for-profit insurance, HR 3962 would put the government in the role of accelerating the privatization of health care,” and Rep. Eric Massa (D-N.Y.) who said, “At the highest level, this bill will enshrine in law the monopolistic powers of the health insurance industry.”

An amendment demanded by Catholic bishops that would expand the prohibition on federal funds paying for abortions to also prohibit subsidized private insurance coverage for abortions split the Democratic caucus, as 64 Democrats joined with 176 Republicans to pass Rep. Bart Stupak (D-Mich.)’s amendment.

Other progressive single-payer (and abortion-rights) advocates, such as Donna Edwards (D-Md.) and Raul Grijalva (D-Ariz.), gave in to pressure from the White House to move the bill forward. President Obama’s speech to the House Democrats Saturday may have won over a few critical votes. John Nichols noted at TheNation.com that Rep. Pete Stark (D-Calif.) summed up progressive sentiments when he explained why he was voting for a measure that was far weaker than he would have preferred. “At my age,” said Stark, “I’ve learned to take what you can, when you can get it.”

At least the Dems got one Republican — Rep. Joe Cao, a first-termer who won last year in a fluke from New Orleans — to vote for health reform, so now Obama can claim it’s a bipartisan bill and forget about appealing to Sen. Olympia Snowe (R-Maine).

While much of the debate on health-care reform has concerned the creation of the “public option,” which is limited in scope and would not take effect until 2013, HR 3962 (the Affordable Health Care for America Act), as it emerged from the House, would provide important help for middle-income families immediately. Effective Jan. 1, it would stop insurance companies from arbitrarily rescinding coverage when patients file claims. It strips the health insurance industry of its exemption from antitrust laws covering market allocation, price fixing and bid rigging. And the bill would end lifetime caps on how much insurers will cover, which is a leading cause of family bankruptcy. (See more in Dispatches, page 5.)

By 2013, HR 3962 would create an exchange in which millions can buy insurance — including the choice of a public health insurance option to compete with insurance companies. Businesses with payrolls greater than $500,000 would have to pay at least 72.5% of their employees’ insurance and 65% of family coverage. Small businesses would get tax credits to offer health coverage. Lower- and middle-income families up to 400% of the poverty level ($88,000 for a family of four) would get federal subsidies to help them buy insurance.

The bill also would end denials of coverage for pre-existing conditions and it would end co-payments for preventative care.

The bill allows the Secretary of Health and Human Services to negotiate drug prices for Medicare and it requires pharmaceutical companies to rebate the government for drug overcharges that arose after 2003 when low-income elderly people who got their drugs through Medicaid were enrolled in Medicare Part D.

Under the House bill, 36 million uninsured Americans would become eligible for coverage. Medicaid would cover 15 million of the poorest children and adults while 21 million would buy coverage on a national national insurance exchange, either from private plans or from the government-run “public option” with the federal subsidies for low- and middle-income families. The nonpartisan Congressional Budget Office estimated that only 6 million people would choose the public plan, making it a relatively small player.

Among major differences between the two chambers, the House bill would require employers to provide coverage; the Senate does not.

The House pays for much of the 10-year $894 billion cost with a surtax on people earning more than $500,000 a year (or $1 million for couples). The CBO projected that the House bill would cut $104 billion from budget deficits over the next decade. The Senate would impose fees on the health-care industry and a 40% tax on “high-value” insurance plans, which would encourage businesses to cut back on their benefits. That has organized labor as well as business groups howling. On financing, the Senate should defer to the House, which is responsible for originating tax bills anyway.

For those 36 million who will at least have a shot at getting insurance — and for the rest of us who have insurance but cannot be sure that our medical needs will be covered when they come up for review by corporate bureaucrats — we cannot agree with single-payer advocates who say the compromise bill is worse than no bill at all.

This bill will not be the last word on universal health coverage. If we elect more and better progressive populists to Congress, we can try to make it better. But this bill is an important first step.

Now that the House has passed its version of health-care reform, the action moves to the Senate, where grandstanding Sen. Joe Lieberman (I-Conn.) renewed his pledge to join the GOP in a filibuster of any health reform with a public option.

If that’s the case, if Democrats lose their 60th vote needed to shut down the Republican filibuster, Lieberman should be stripped of his committee chairmanship, since cannot be trusted on important procedural matters by the caucus. Then Democrats should proceed to pass a Medicare-for-All public option in the budget reconciliation, which is not subject to filibuster.

Sen. Bernie Sanders (I-Vt.) will try to attach an amendment to the Senate bill similar to Kucinich’s stricken provision allowing states to proceed with their own single-payer plans. Good luck. But the Senate should reject the House’s overreaching language restricting abortion coverage in private insurance plans.

So far it’s been progressives who have been called upon to compromise on the principle of universal health coverage. It’s past time for Democratic leaders to stiffen their backbones. Republicans like to call Obama a “Chicago pol” but we’d like to see a little more hard bargaining as we near the end-game of health-care reform. Democrats need to show the insurance lobby that the cost of obstruction is greater than the cost of agreeing to a compromise — which is what the House produced and the Senate is preparing to debate. The best way to get the insurance lobby to play ball is to make a credible threat that the alternative to a bipartisan vote in the Senate agreeing to the insurance reforms with a strong public option is a party-line vote that will put the insurance companies on the fast track to going out of business next year. That’s the Chicago way. — JMC

From The Progressive Populist, December 1, 2009


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