The Health Care Climb

I am generally pleased with Obama's framing of the health care debate, if not his solution. He is right to say that health care is a fiscal as well as a moral imperative. Federal and state budgets, businesses with one employee or 50,000, and tens of millions of individuals are hurting badly from the soaring costs of health care. And it's encouraging to see so many Republicans agreeing with the fundamental premise that we cannot go another year drifting along with the status quo. But let's get real - one day of happy talk does not a deal make.

But at least one forum participant, West Virginia Senator Jay Rockefeller, wasn't feeling so cheery.

Rockefeller is no enemy of reform. On the contrary, his record on health care issues belongs right up there with Henry Waxman's and Ted Kennedy's.

But in the last few months, Rocekefeller has on more than one occasion pierced the prevailing mood of optimism with warnings about what's possible--and what isn't--in this legislative environment. On Thursday, he was at it again:

I want to issue a warning …There’s all this talk of, "It’s all going to work, we’ve finally reached it, with the president behind it, people want it." And I go back to the Clinton bill. Every single poll they took showed 72 percent of Americans said they’d be willing to pay two dollars more for universal healthcare. They didn’t mean it. They didn’t mean it. They didn’t want to do it. … There are a lot of people who have an interest, and let this be said bluntly, in keeping costs high, in making sure that medical companies make money. That leads me directly to the rudest thing I am going to say, which is the power of lobbyists.

Rockefeller is making two separate points here--one is about the fickle nature of public opinion on health care, particularly when the public is still pretty uninformed about the debate; the other is about the power of lobbyists to block reform, so that they can hold onto their profits. On both counts, unfortunately, Rockefeller is making sense--and I say that as a well-known optimist myself.

The same special interests are invested in the status quo, as they were in 1993-94, when they ultimately decided their self-interest was more important than getting something done. And they've invested heavily in politicians to make sure their agenda trumps the needs of the public.

Health insurers and drug makers have showered members of the 111th Congress with millions in campaign contributions over the last four years, with a special focus on leaders who will play major roles in shaping health-care legislation, according to a study to be released tomorrow.

Health insurers and their employees contributed $2.2 million to the top 10 recipients in the House and Senate since 2005, while drug makers and their employees gave more than $3.3 million to top lawmakers during that period, according to an analysis of federal elections data by Consumer Watchdog, a California-based advocacy group.

The biggest beneficiaries in the Senate included John McCain (R-Ariz.), with $546,000; Minority Leader Mitch McConnell (R-Ky.), with $425,000; and Max Baucus (D-Mont.), with $413,000, who as head of the Finance Committee will play a leading role in the debate over health-care reform.

There is a difference this time around. We have Health Care for America Now and a series of other progressive groups who will fight on the other side of this. But let's not diminish the power of groups like America's Health Insurance Plans, who blithely proposed that we kick the entire policy over to an independent commission to sidestep the Democratic committee chairs (or maybe just to obfuscate and delay the whole process).

Success or failure in the process will depend on whether Obama is willing to stand up for elements like the public option, the way he did to Chuck Grassley at the health care summit.

Another interesting exchange came between Obama and Senator Chuck Grassley, the ranking Republican on the Finance Committee. "Max Baucus and I have a pretty good record of working out bipartisan things," said Grassley. "I think only two bills in eight years that haven't been bipartisan." (One of them, however, was the S-CHIP bill, and another was Medicare payment reform, so their record on health care is more contentious). Grassley then moved onto a more relevant sore spot: The public insurance option. "The only thing," he pleaded, "that I would throw out for your consideration -- and please don't respond to this now, because I'm asking you just to think about it -- there's a lot of us that feel that the public option that the government is an unfair competitor and that we're going to get an awful lot of crowd out, and we have to keep what we have now strong, and make it stronger."

The question was no surprise: In recent Finance hearings, Grassley has clearly signaled his anxiety on this issue. What was a surprise was that Obama rejected Grassley's plea to think it over and instead replied on the spot with a strong articulation of the case for a public plan. "The thinking on the public option has been that it gives consumers more choices, and it helps give -- keep the private sector honest, because there's some competition out there. That's been the thinking."

"I recognize, though, the fear that if a public option is run through Washington, and there are incentives to try to tamp down costs and -- or at least what shows up on the books, and you've got the ability in Washington, apparently, to print money -- that private insurance plans might end up feeling overwhelmed. So I recognize that there's that concern. I think it's a serious one and a real one. And we'll make sure that it gets addressed."

The public option will make this work. And there are a host of other pieces that will have to be protected as well. If we're going with the Rube Goldberg contraption, it offers more opportunities for special interests to subvert the plan and defeat it even if it's signed into law. I'd prefer something cleaner. But regardless, we're in for a fight.