It’s not easy being Speaker of the House. Just look at the Herculean task Speaker Nancy Pelosi has on health care reform. Her job is to herd 256 Democrats toward a consensus – Democrats who come from diverse districts and, as a result, bring to the House diverse perspectives. Her caucus is currently engaged in a harsh and public ideological battle over health care reform, and specifically on the issue of a government-run insurance plan.

It appears that Speaker Pelosi has decided on a strategy for dealing with this division, and it’s a page out of former-Senator John Edwards playbook. Last year when he was still a candidate for President, Senator Edwards displayed his flair for demagoguery by vilifying insurance carriers as unworthy to be part of the health care reform debate. Now Speaker Pelosi is going further.

Glenn Thrush described the Speaker’s outburst at Politico.com, Speaker Pelosi was asked about liberals objecting to compromise on health care reform. He quotes her response, "’The public option — that’s where the insurance companies are making their attacks — it’s almost immoral what they are doing,’" said Pelosi, addressing reporters outside of her office a few minutes ago.

"’Of course, they’ve been immoral all along,’" she added. "’They are the villains in this, they have been part of the problem in a major way. They are doing everything in their power to stop a public option from happening and the public has to know.. They have had a good thing going for a long time at the expense of the American people and the health of our country.’"

Remember President Barack Obama’s call for for a civil debate in which “we can disagree without being disagreeable?” Speaker Pelosi apparently missed the memo.

Making the insurance industry the immoral villain may be good politics. The American public and their representatives love having a bad guy to boo. Black and white arguments generate a lot more sound bites than do debates painted in nuanced shades of gray. Slotting insurance companies into that role is a no-brainer. The public doesn’t trust insurance companies concerning health care reform and the industry has shown a startling lack of political skill over the years. Let’s face it, insurance carriers have auditioning for the villain role for years. Congratulations, you’ve got the part.

But should they be cast as immoral? Immoral people are unfit to participate in civil society. They are cast out from the community. They are less than the community. Is this what the Speaker of the House means? Is it what she believes? Is this the kind of language she should bring to bear on an opponent over a public policy issue? And is it really smart politics to describe an opponent on an issue as immoral when that opponent, if she were being fair about it, is backing a great deal of the health care reforms put forward by Democrats?

Speaker Pelosi supports a strong public policy option. I believe she sincerely believes it will “keep insurers honest,” increase competition in the market and help reduce health insurance premiums. She could have used her bully pulpit to educate voters on why she believes what she does. She could explain how a public plan paying less than health care providers actual costs strengthens the health care system in the United States. She could have explained why a public plan needs government-bestowed advantages to compete with private carriers.

Instead she chose the low road of a Glenn Beck. Mr. Beck, however, is an entertainer, not a political leader. His job is to create controversy without regard to reality and, shamefully, to inspire the worst in people. Speaker Pelosi’s job is to legislate and educate. Hers is a much higher calling than Mr. Beck’s. She should be held to a higher standard.

Legitimate concerns have been raised concerning the efficacy of a government-run health plan and its ability to create a competitive market without destroying that market. Speaker Pelosi owes it to the American public to address those concerns. In providing that explanation criticism of the health insurance industry will be be warranted, but such criticism cannot be the entire explanation. Nor does the criticism need to be less than civil.

The Bush Administration made an art form out of casting opponents to its policies as immoral and unpatriotic. Speaker Pelosi used to oppose that kind of politics and she was right to do so. She is wrong to embrace it.

Posted in Health Care Reform

Just looking at the broad facts, liberals should be riding high. President Barack Obama occupies the White House. Democrats hold a 60-40 super-majority in the U.S. Senate and a commanding 256-178 majority in the House (with one more on the way after a special election in California later this year). Republicans are on an electoral losing streak of epic proportions and have yet to find a unified voice. It doesn’t get much better than this.

Except appearances can be deceiving and liberals will soon need to decide whether they are willing to vote for a bill that, in their view, improves America’s health care system but does not go nearly far enough or should they leave the system the way it is.

The evolution of health care reform legislation as it moves through Congress must frustrate progressives. It started off to their liking. Senator Edward Kennedy’s Health, Education, Labor and Pensions Committee pushed forward a bill that satisfied much of the liberal wish list. Good times continued when the House Ways & Means and the Education & Labor Committees passed equally progressive bills. That the affirmative votes on all three committee came exclusively from Democrats was not of great concern to supporters. Health care reform was coming whether Republicans wanted to join the parade or not.

Liberals were on a role, but then their moderate and conservative colleagues began to make their presence felt. And there are more of them than is generally acknowledged. While conservative talk show hosts like to brand the Democrats as a monolithic subsidiary of Mao-spouting communists, the reality is far different (actually, reality is usually different than that described by conservative talk show hosts, but that’s a topic for another day).  A party does not capture 60 percent of the Senate and 59 percent of the House by running cookie cutter candidates all pledged to the same ideology. The country is too diverse. The brilliance of Rahm Emanuel, then head of the Democratic Congressional Campaign Committee and now White House Chief of Staff, was that he discarded virtually the entire Democratic litmus test in his search for candidates. The only significant requirement he demanded of the candidates he recruited was that, once elected, they would vote for a Democrat for Speaker of the House. Meanwhile, the GOP who hewed closely to the beliefs and principles of their base. Moderates were scorned and labeled RINOs (Republicans in Name Only). They succeeded in recruiting ideologues who had no chance of winning outside the reddest of red districts.

Consequently, the Democratic caucus is chock full of moderates and even conservatives.  Which all but guarantees that liberals will be disappointed. There are simply not enough liberals in Congress to pass a bill without support from moderates.

So it should not have been a surprise when problems developed as the progressive juggernaut moved beyond some of the most liberal committees in Congress. The Blue Dog Coalition, a group of moderate Democrats in the House, objected to a host of provisions in the Ways & Means and Education & Labor bills. While they lacked the votes to hold up the legislation in those committees, they did such leverage in the the House Energy & Commerce Committee. The Blue Dog Democrats had an agenda for health care reform that differed in many respects from that of their more liberal colleagues.

Meanwhile, in the Senate, Democrats and Republicans on the Senate Finance Committee were working tirelessly to hash out a health care reform package that could garner bi-partisan support. To get there, Senator Max Baucus, Chair of the committee, was willing to jettison some of the more treasured elements of the liberal health care reform agenda.

Both the Blue Dog Democrats and the moderates on the Senate Finance Committee are making substantial progress. House Energy & Commerce Committee Chair Henry Waxman and Representative Mike Ross, speaking on behalf of the Blue Dogs, announced an agreement that will allow the full committee to begin marking up health care reform legislation. The specific changes to the bill from the versions passed by the Ways & Means and Education & Labor Committees are not yet public. That they will be substantially more moderate is a certainly, however. At the same time, Senator Baucus and the ranking minority member of the committee, Senator Chuck Grassley, are making it known they are close to unveiling the Senate Finance Committee’s compromise.

These proposals will not include a government-run health plan. They may not include all the mandates and subsidies liberals seek. In short, they will reform the health care system, but leave much of what exists in place. Which puts progressives in an uncomfortable position.

Moderates and conservatives seem willing to defeat any health care reform legislation rather than vote for the kind of reforms liberals seek. Will liberals refuse to support legislation that does not go as far as they demand?

That’s not yet known. That the compromise proposals will be attacked from both the left and the right is to be expected. And liberals are already expressing outrage at having their wishes denied. For example, the Associated Press quotes Representative Lynn Woolsey  as saying “They can’t possibly be taking us seriously if they’re going to bring this [compromise legislation] forward.”

But will liberals insist on getting their way even if it means letting the status quo stand?

Ideology and pragmatism are often hard to reconcile, but my prediction is that liberals will vote for moderate health care reform. The reason: Senator Kennedy and President Obama will eventually accept a compromise. Throughout his career Senator Kennedy has demonstrated the political wisdom of taking half a loaf now and continuing the fight for the rest another day. And, according to the Associated Press story cited above, the White House is already making clear the Administration is willing to settle for a more moderate bill.

With Senator Kennedy and President Obama’s urging, enough liberals will accept that even modest reform is preferable to the status quo. They won’t be happy with what it contains, or more accurately, what it doesn’t contain, but they will be among those applauding when President Obama signs the bill into law this Fall.

Added 9:05 pm July 29, 2009: As noted above, liberals are upset over any compromise that does not include a public health insurance plan. In a post on Politico.com, Glenn Thrush reports that “Two months ago, most of the 80-plus members of the Congressional Progressive Caucus signed a pledge that they would oppose any health care bill that didn’t contain a bona fide public option that would compete with private insurers. On Wednesday, they seemed willing to stick to their promise.”  He goes on to quote Representative Barney Frank as saying liberals might reject the House leadership’s  request to support a weakened public option. “I don’t think it would pass the House — I wouldn’t vote for it,’” the post quotes Rep. Frank as saying.  No one would cheer louder than Republicans to see health care reform fail because moderate and liberal Democrats fail to come together. Which is, to repeat my prediction from above, why I think liberals will eventually take a deep breath, vote for a moderate bill, and come back in 2010 fighting for more.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics Tagged: Barney Frank, Charles Grassley, Edward Kennedy, government health plan, Henry Waxman, House Education and Labor Committee, House Energy and Commerce Committee, House Ways and Means Committee, Lynn Woolsey, Max Baucus, public insurance plan, Senate Finance Committee, Senate Health Education Labor and Pensions Committee

We’re getting closer to seeing what the health care reform likely to emerge from Congress will actually look like. The Senate Finance Committee is likely to unveil its bi-partisan reform plan in the next few days. While it’s likely to disappoint members of both parties, it also holds out the greatest promise for serving as a framework for meaningful, comprehensive reform.

Some of those who will be disappointed with a more centrist approach to health care reform will be those who have created a cottage industry from highlighting the more egregious elements of the plans already passed by Congressional Committees. These proposals never had much chance of becoming law, but partisans across the spectrum embraced them as either statements of principles (on the left) or evidence of skullduggery (on the right). countless hours of heated argument, outraged accusations, misinformed attacks, and righteous indignation have been heaped on these bills. They also generated, to be fair, serious public policy debates on meaningful issues that shined a light on the complexity and trade-offs inherent in reforming one-sixth of the nation’s economy. They received all this attention in part because they were the only detailed reform plans around.

The Senate Finance Committee is about to change that. And it could be the House Energy and Commerce Committee, whose liberal and moderate Democratic members are seeking to find common ground, may also come forward with a detailed plan soon.

The health care reform proposal likely to emerge from the Senate Finance Committee will disappoint some in the White House. According to the Associated Press, it does not call for creating a government-run health plan as President Barack Obama has proposed to provide competition for private carriers. Instead, such competition would be provided by non-profit health insurance cooperatives. While the federal government would provide seed money for launching these cooperatives, they would have to survive in the market without government subsidy or management. The Senate Finance Committee is also expected to forgo requiring businesses to offer health insurance coverage to their employees, although individuals would be required to obtain such coverage on their own if their employer does not offer it.

There will no doubt be much in the Senate Finance Committee’s proposal to raise the ire of, well, most everyone. If there was a path to health care reform that triggered spontaneous outbursts of Kumbaya in the halls of Congress, it would have been introduced and enacted by now. So we get to look forward to plenty of controversy, sniping, partisan positioning and serious policy debate over the next several weeks.

The good news, however, is that all that energy will be directed to refining a health care reform plan that has the chance of actually being enacted. And that is progress.

Posted in Barack Obama, Health Care Reform, Healthcare Reform, Politics Tagged: government health plan, health insurance cooperatives, House Energy and Commerce Committee, public health insurance plan, Senate Finance Committee

One thing everyone can agree on: there is no perfect health care reform legislation. Every idea has flaws. Every proposal presents problems. This is the reality, but it should not be an excuse for doing nothing. Because the status quo is flawed and problematic, too. And the longer it takes to address the fundamental problems of the current system, the worse the cure will be.

This is a point President Barack Obama made in his press conference on July 22nd. Calling the status quo a “back-breaking alternative plan” he positioned the situation accurately. What’s being debated in Washington is not just the risks and benefits of change, but the cost of doing nothing.

Steven Pearlstein made the same point in his Washington Post business column. “Among the range of options for health-care reform, there’s one that is sure to raise your taxes, increase your out-of-pocket medical expenses, swell the federal deficit, leave more Americans without insurance and guarantee that wages will remain stagnant,” he writes. “That’s the option of doing nothing ….”

It is becoming increasingly difficult to argue for the status quo, yet that’s what the “no reform” advocates are doing. They ignore the financial reality that, unless changes are made, the current system will increase government deficits and shackle business expansion. Eventually changes will be made. The longer the tough decisions concerning what changes to make are put off, the more onerous the eventual changes are likely to be – single payer anyone?

This is not to say that proposals currently on the table are better than the current system. Some would definitely make matters worse. What it argues for is giving those seeking comprehensive and responsible reform to do their work. As Mr. Pearlstein points out, the broad outlines of reform are swirling around Washington: shifting reimbursement from fee-for-service to quality, requiring carriers to sell and consumers to buy coverage, preventive care, and accelerating the adoption of medical technology. I’d add to the list the likelihood that calls for a public plan will morph into acceptance of health insurance co-operatives, owned by its members. This is the direction in which I hope the health care reform debate will move. But what matters is keeping it moving.

Because the status quo is an alternative that may be reassuring to some now, but is likely to result in far worse reforms i the future.

Posted in Health Care Reform