Time for a real national health plan

Now that the U.S. Supreme Court has signed off on the Affordable Care Act, Congress needs to go back and create a decent national health care plan. The Affordable Care Act (A.C.A.), known as “Obamacare,” isn’t it.

It was important for supporters of the A.C.A. to support the court case while it was pending in order to establish that Congress is within its authority to create a national health care plan. But that doesn’t mean the nation must now live with the mess that the A.C.A. is.

From the beginning of this fight, neither side has been a source of good information or a source of a good lawmaking process. As Trudy Lieberman, who has provided the best news coverage of the A.C.A., wrote in the current Harper’s, the Democratic Party has reflexively defended A.C.A. “as cheerleaders,” and the Republican Party “has confined itself to disinformation and risible smears.”

The A.C.A. is the product of a dysfunctional Senate. Nevada’s Harry Reid failed to do anything about the silent filibuster before the health-care debate got underway. As a result, any single senator had the power to bring the whole lawmaking process to a halt, and several ersatz Democrats—Ben Nelson, Blanche Lincoln, Joe Lieberman—took full advantage of that sanity-challenged section of Senate process to screw up the A.C.A., withholding their essential 61st votes unless they were pampered and porked and satisfied.

In addition, Reid neglected to observe the lessons of the failed Clinton health care plan, chief among them to get the job done fast so that an endless debate could not be portrayed by critics as foreshadowing a complicated and bureaucratic program. As the Senate debate wore on month after month, public sentiment soured on the A.C.A.—and implementation of the program was pushed back.

By eliminating the public option and responding to the party’s new corporate funders, the Democrats ended up throwing the nation’s patients right back into the arms of those who helped create the problem in the first place—insurance companies. That left the trappings of managed care, including the little bureaucracies that every doctor’s office must have, in place. It was a massive betrayal. Further, the Democrats did little to free the health care system from the hold that drug manufacturers and hospitals have, leaving unfulfilled the promise that patients would control their own health care.

Finally, the Democrats failed to listen to their base. When major unions—the Teamsters, the United Food and Commercial Workers International Union, and Las Vegas-based UNITE-HERE—withdrew their support from the A.C.A., the Democrats yawned.

Trudy Lieberman has pointed out that there are indications that health care costs, instead of going down, are going up. Further, she writes, “Too many Americans are still excluded; the process of buying insurance remains incredibly complicated; there is little regulation throughout the country; and millions of people are saddled with huge out-of-pocket expenses and lack the coverage they need.”

The Republicans are never going to accept the idea of a national health care plan. But now the Democrats are saddled with a corresponding blind spot. Will they ever accept the idea that they haven’t solved the health-care problem? In case they haven’t noticed, all across the nation, people who used to complain about health care are now complaining about Democratic health care.

When the party gets its majority back, it needs to do the job right.