Is the health care overhaul staggering through the Senate this week the most important social welfare legislation in a generation, as Democratic leaders claim? Or is it so compromised that the final product is not worth the agony, and the political risk, required to produce it?
The bill that cleared its first crucial test vote in the wee hours Monday morning has become a make-or-break gamble for President Obama and his party. They infuriated liberals by removing the plan’s “public option” and dropping an expansion of Medicare, without earning any credit from Republicans who insist the plan will be a financial quagmire for the government and that it will do little, ultimately, to rein in runaway medical spending.
Even after all the drama of the past several weeks, it remains to be seen whether the House and Senate can ultimately reconcile the two very different plans that barely drew enough support to pass in each chamber. If they cannot, the enterprise that has consumed Congress for the past six months will still be for naught.
Was it worth all this, or did the White House and its allies simply get caught up in a testosterone-fueled smackdown in which, ultimately, they had to win by ramming something — anything — through Congress despite Republican objections and obstruction?
It was not as witless as that. For all the compromises it took to get this far, each legislative chamber has, for the first time, voted to require that every American have health insurance, that companies be prohibited from denying coverage due to pre-existing conditions, and that the government must subsidize coverage for citizens who, though not impoverished, are deemed to be unable to afford the full price on their own. When you add this up, this means health coverage would become a right and an entitlement as well as a responsibility.
Most Democrats see health insurance as a right and don’t mind entitling everyone to receive it. Most Republicans probably see it as a responsibility, and are not inherently opposed to requiring everyone to have coverage. Since it is clear that everyone cannot pay for insurance, Republicans also implicitly favor providing some sort of subsidy for those who need it.
The basic elements for an agreement are in place. There were efforts, especially in the Senate, to get the two parties to come together on some sort of joint plan. Democrats ultimately abandoned hope for a bipartisan approach when they became convinced, not without reason, that most Republicans were more interested in denying Obama a signature political achievement than in actually getting anything accomplished.
This, however, was not the entire story, either. Democrats chose to push health reform forward just after Obama took office, when their legislative majority was most likely at its peak, before making any serious effort to deal with Washington’s long-term financial problems, especially Social Security and Medicare. Democrats also brought an entire dairy barn full of sacred cows into the process. They proposed to entitle everyone to medical care without any serious attempts to control costs, and without making most Americans pay what their care really costs to insure.
Republicans feared, also not without reason, that most Democrats ultimately want to saddle business and a few relatively well-off Americans with the cost of providing nearly unlimited care at virtually unlimited prices to the entire population.
So Republicans dropped out of the process and Democrats, forced to hold their entire fractious party together to get something passed, developed a debacle of a bill in the House, and then did even worse in the Senate.
They redefined “cost control” so that, rather than try to limit the share of national output going to health care, they would call themselves successful if they merely kept their overhaul from increasing the federal budget deficit. That would be fine if all medical spending was done by the federal government, but it isn’t. Besides significant new taxes, Democrats mandate that states pick up a substantial share of the cost of insuring the entire population through the Medicaid program for the poor.
States other than Nebraska, that is. To secure that crucial final vote from Sen. Ben Nelson, Democratic leaders promised that any additional Medicaid costs in Nebraska would be paid, to the last dollar, by Washington. No other state has such a deal. Not Michigan, with its gasping auto industry and its critical inner city problems in Detroit. Not Obama’s Illinois, or near-broke California, or New York, where generous Medicaid allowances are eating state and county budgets alive.
If that legislative atrocity is ultimately enacted, universal health care in those places may consist of one-way bus tickets to Omaha, where the indigent can get medical care on Uncle Sam’s dime.
And Democrats, whose party has been the political home of nearly all pro-choice Americans since Ronald Reagan’s time, threw abortion rights under the bus in both houses to secure passage of their health reform bills. The ultimate political damage is unknowable now, but I think it will be severe. Democrats assume that pro-choice voters will find no alternative in the resolutely anti-abortion Republican ranks, but that does not mean those pro-choice voters will bother to vote at all. Down the road, relatively affluent voters may decide to try to change the Republicans from within rather than stay with Democrats who take them, and their money, for granted.
One thing is certain: Democrats have committed a startling amount of political capital to this issue. The elections of 2010 and 2012 will show whether they made a wise investment.