Is it worth it?

Democrats succeed in passing watered-down health care legislation

The White House caption for this official photo says that the arm adjusting President Obama’s tie belongs to U.S. Sen. Harry Reid of Nevada. After Reid cleared the way for a health care bill, Obama said, “I’m grateful to Sen. Harry Reid and every senator who’s been working around the clock to make this change. … These are not small changes. These are big changes.”

The White House caption for this official photo says that the arm adjusting President Obama’s tie belongs to U.S. Sen. Harry Reid of Nevada. After Reid cleared the way for a health care bill, Obama said, “I’m grateful to Sen. Harry Reid and every senator who’s been working around the clock to make this change. … These are not small changes. These are big changes.”


U.S. Senate Democrats collapsed across the finish line this week, scoring an uncertain victory in the early morning hours of Monday with legislation that fell far short of the “affordable, comprehensive healthcare” promised by the party in the 2008 election.

In an email message to Nevadans, Senate Democratic leader Harry Reid of Nevada said the measure will “rein in costs even further, make care more affordable by expanding small business tax credits, demand even greater accountability from insurance companies, create more choice and competition for consumers.”

The legislation teed up for passage when Democrats voted to end debate and move on to voting was like the elephant in the tale about the group of blind men—everyone who touched it described a different beast. Some described it as, if not the comprehensive plan promised, still a huge step ahead in protecting the public. Others—and they included both liberal Democrats and conservative Republicans—found innumerable faults in the bill.

In an editorial headlined “Change Nobody Believes In,” the Wall Street Journal called the measure “a bill so reckless that it has to be rammed through on a partisan vote on Christmas eve.” In an election, a 60 percent majority is a landslide, but the Journal called 60 out of a hundred votes in the Senate a “narrow majority.”

Yale political scientist Jacob Hacker, who wrote a book on health care reform and said he was “devastated” when the public option plan “was killed at the hands of Senator Joe Lieberman,” wrote in the New Republic that passage of the Democratic bill was still essential: “The lack of a public option also makes even more imperative tough requirements on insurers to make them live up to their stated commitment to change their business model and slow the spiraling cost of coverage.”

Immediately after the Democrats voted to end debate and move on to voting on the bill, Time magazine asked if Sen. Reid had made the battle tougher than it had to be and concluded he had not: “Reid, says [former Democratic leader Tom] Daschle, had no choice but to [initially] offer the public option. ‘He was under intense pressure from the House [which has one in its bill] and the liberals in the caucus to at least make the effort.’ Also, by including the option, Reid gained a valuable bargaining chip—something he could give up in negotiations to win the votes of more conservative members like Connecticut’s Joe Lieberman, an independent who is counted as part of the Democratic caucus, and Nebraska’s Ben Nelson.”

That still leaves the question of whether the bill that emerged at the end was worth the effort. In last year’s election, the public stuffed substantial resources into one end of the pipeline—a Democratic president and a huge Democratic majority. What came out the other end of the pipeline this week was a trickle compared to the program Obama and the party had promised. Moreover, if the Democrats cannot accomplish a national health insurance program now, it will probably not do so in this generation—how often does a political party have the advantages the Democrats enjoy this year?

On Dec. 8, Senate Democrats ended their effort to pass a bill containing a public option in favor of a proposal allowing 55-year-olds without coverage to buy into Medicare. Then on Dec. 14 the Medicare proposal was similarly dropped to appease the blue dog Democrats. Either measure had 51 votes to pass the Senate, but Democrats were unwilling to return majority rule to the Senate by dropping an arcane procedure requiring 60-vote majorities to end imaginary filibusters.

Under the imaginary filibuster system, a single senator in the 60-senator Democratic majority enjoyed a veto over the bill, and several Democrats used—or abused—that leverage to deny the majority a chance to vote for a bill reflecting majority sentiment. In effect, Nelson and Lieberman used their single votes to defeat bills that most of their colleagues wanted to enact.

The loss of both the public option and the Medicare substitute infuriated regular Democrats. Former Vermont governor Howard Dean, a physician, told a public radio station in his home state, “This is essentially the collapse of healthcare reform in the United States Senate. And, honestly, the best thing to do right now is kill the Senate bill. … There are some good things in this bill, but they’re small.” Dean, as Democratic national chair, was an architect last year of the party’s national electoral victory.

The AFL/CIO and the Service Employees International Union, strong Democratic supporters, declined to support the Democratic bill.

But Ohio Democratic Sen. Sherrod Brown reluctantly stuck with the new bill, saying the issue should not be individual senators. “And it’s not [about] me, it’s not about any senator, it’s not about Lieberman, it’s not about Harry Reid.”

Cost containment

Massachusetts Institute of Technology economist Jonathan Gruber has tracked the cost containment provisions of the ever changing Democratic measure all along. He was one of a couple of dozen economists who sent a letter to President Obama insisting that “deficit neutrality” had to be one of four essential elements to any health-reform bill. He has previously told reporters he was skeptical that cost containment will be one of the outcomes of the health reform fight.

Last weekend, Gruber told the News & Review that the new Reid measure retains and improves the cost containment provisions that were already strong in the previous bill: “Cost containment is in fact improved in this version. Most importantly, the independent board that can make recommendations on payment reform now has tighter targets—and can recommend changes for both Medicare and the private sector. This bill goes much farther on cost control than I, for one, thought was politically possible in today’s environment.”

Republicans who stayed out of the debate over health care except to criticize Democratic efforts undertook some half-hearted efforts at the end to stop the bill. They tried unsuccessfully to hold up military spending—including troop funding—to keep the Senate from moving on to the health care issue. They invoked a rule requiring that an amendment “be read aloud.” But the GOP effort at a “read-a-thon” became less of an obstacle when Independent Sen. Bernie Sanders of Vermont withdrew his own 767-page amendment (creating a national single-payer health care system) in order to stop the Republican stall and let voting begin. That still left the reading of the 383-page amendment introduced by Reid on Saturday, which was read aloud by clerks starting at mid-morning Saturday and ending at exactly 4 p.m.

The final version of the bill, estimated to cost $871 billion over the next 10 years, contained new language on abortion (allowing states to opt out of abortion coverage) and Nebraska-related goodies to give blue dog Nelson a reason to provide Reid with what the New York Times called “the handshake of a lifetime.”

After Reid obtained that 60th vote, the National Republican Senatorial Committee put out a statement saying that “polling data among Nevada voters continues to show Reid’s constituents are strongly opposed to the legislation on which the Majority Leader has seemingly staked his reelection.” The committee cited a Las Vegas Review-Journal poll to support its claim. However, that survey was taken two Democratic healthcare plans ago, when the Senate was still debating Reid’s public option plan.

Gruber said that Reid “has truly been a hero on this issue—especially given that he faces reelection this year.