Time To Stand Up To Powerful Interests

The other big news today is that we'll see a House health care bill out of the Tri-Committee process. It will include a public option that bargains with near-Medicare rates for the first three years, and it's partially financed by progressive taxes on the wealthy. There seems to be a lot of discussion about the timetable of the legislation, which I think really should be a secondary issue. Missing deadlines is as fundamental to the Congress as bloviating speeches. We don't need this fast, we need this right.

As to how to get there, as Mike Lux says we have an easy choice. We can compromise with a minority who do not believe Medicare and Medicaid should have ever existed and give in to those who warn about the cost of providing health insurance to everyone, while positioning themselves as defenders of health care providers to reap their share of funds. Or we can ignore these dissemblers and design a system that works for people instead of industries that value profit. The fight will be long and tough, and details matter.

On a broad array of contentious issues – from government’s role in providing insurance to the size of subsidies for lower-income Americans – the liberals who largely control the agenda in the House are holding fast to their principles. The legislation expected to be formally unveiled, perhaps as soon as today, will reflect their vision of how to insure nearly all Americans and how to pay for it – including a proposal to tax the wealthy that was announced Friday.

But the Democratic liberals face stiff challenges from moderates and conservatives in their own party on the price tag of legislation. Growing pressure to lower the cost to $1 trillion or less over ten years poses a threat to their foremost goal of guaranteeing Americans comprehensive, affordable coverage.

Peter Harbage, a fellow at the Center for American Progress, a liberal think tank, says the impact of legislation will vary sharply depending on how well it’s financed. “In terms of uninsured families, will they end up paying out of pocket between 5 percent and 8 percent of their income for health insurance, or is it going to be 17 percent and 20 percent of their income?” he asks. “If it’s 20 percent, that’s better than what some families have today, but it’s difficult to see how progressives are going to see that as a victory.”

On these and other issues, that choice I described earlier keeps coming up. And in the end, people will know, in their monthly statements and in the quality of their care, whether Democrats capitulated or not. As Lux says, the choice is clear.

The internal debate on health care strategy for Democrats can be boiled down to this: do we choose the approach whose specifics are more popular with the public and will almost certainly work better in practice once it gets passed, or do we want to go with something that has some bipartisan support and may avoid an all out war with the insurance industry? [...]

The first thing to understand in all this is the consequences for the Democrats for the next generation and probably longer if they pass some convoluted, complicated, unworkable compromise that doesn't change the abusive patterns in the insurance and pharmaceutical industries and doesn't begin to control health care costs. If they pass a compromise that doesn't meet regular people's needs, folks will figure it out very quickly, as most people deal with the health care system all the time. If the Democrats twist up this bill to make insurance companies and their Republican allies happy, it is end of story for this generation of Democrats -- our party will not recover from screwing up health care.

The second thing to understand is that wealthy, powerful elements of the health care industry, along with the entire right-wing message machine, will oppose any health care reform bill. Democrats trying to avoid a fight should just get over it: they will get one no matter what.

Here's the other thing: having a clear, clean fight -- Obama and the Democrats take on the insurance companies -- is an easier message to win with than the mushy "we're all in this together, we're all partners in solving this problem" thing Obama has been doing so far. Having enemies helps define this fight in Obama's favor, especially when the enemies are as unpopular as the insurance companies.

It's amazing that, with a Democratic majority in both houses of Congress, indeed a super-majority in the Senate, and with a Democrat in the White House, getting the most popular and effective policy can be seen as a triumph of the little guy. But that's where we're at. And we're ready to keep fighting.

...the release of the Tri-Committee bill may get delayed a day.