Obama’s health care reform under threat from “centrist” Democrats

It’s beginning to look like a possibility that Americans may actually see health care reform happen in this administration, and maybe even this year.

Having lived through the abortive attempt in the early 90s to reform the seriously broken health care industry, I feel obliged to throw more than the usual amount of qualifiers into my sentences when it comes to health care policy. Still, the bill moving through the House is not only a good bill, but one that actually has a few things in common with the proposal coming out of the Senate HELP (Health, Education, Labor and Pensions) Committee. Now if we can just keep the “centrist” Democrats on the Senate Finance committee from selling it out to the heath care interests who fund them, we’ll be in decent shape.

I should say at this point, I suppose, what a “good” bill means to me. A great bill would be Bernie Sanders’ American Health Security Act, which would create a single-payer or “Medicare for All” system in which the government would be the sole funder of health care for all Americans. This is the only—and I do mean only—way to ensure that all Americans are truly covered and can receive health care regardless of income or health conditions.

A system like that hasn’t a snowball’s chance in hell of passing in the US at this moment in time, largely because the foundation has already been laid for the scare tactics—the cries of “Socialism!” and “Government control over health care!” More importantly, the real reason that Republicans and conservative Democrats alike start to whimper about socialism is that without a private health care industry to dump millions on lobbyists, they’d be out a significant chunk of their campaign funds.

So single payer is off the table, and compromise is on it. The real question, then, becomes how far will we bend over backwards to protect health insurance companies’ right to make a profit off of our health, and how much actual health care will we be willing to give up so as not to get called socialists by Rush Limbaugh?

The bill moving through the House contains a few interesting provisions. First, it contains a mandate for Americans to carry health insurance. In other words, there would be a fine if you are caught without health insurance. This is fairly difficult to actually enforce, and is probably in the bill simply to keep insurance companies happy. There’s also an employer mandate, which would require employers to provide health insurance to employees or pay into a public fund that would support the public plan. The amount required would vary by the size of the employer.

But it’s the public plan that is the most important issue—and the one that conservatives will try the hardest to kill. The bill creates a National Health Insurance exchange that would allow individuals to buy health insurance, and it creates a public plan run something like Medicare, that individuals can buy into. Most importantly, the public plan would be subsidized for people making up to 400% of the poverty level.

With a solid, well-subsidized public plan, even industry giveaways like a mandate aren’t so bad. A public insurance plan would be nonprofit, so would need only to make enough money to maintain itself, and by virtue of size and government strength would be able to bargain for better deals for its patients.

Of course, conservatives whine that a public plan won’t be able to compete on a fair playing field with them, as they need to make a profit, but I’d be willing to bet that most Americans don’t actually feel too much sympathy for the industry’s need to skim cash off their maladies. Polls have shown significant support among Americans for a public option. Nate Silver at FiveThirtyEight.com examined several polls, and came up with between 65% and 68% of Americans in support of a public plan option—more than 10% more than the amount that voted for Obama. (Incidentally, more than half of Americans also support a form of national health insurance from the government and for all, but, you know, socialism!)

With a Democratic majority in both houses of Congress and a 60-vote filibuster-proof majority in the Senate, and such high support across the country for a public plan, you’d think it was a done deal, wouldn’t you?

And yet it isn’t. Even if you leave out the need or desire for any Republican votes—something that both President Obama and prominent Democrats like Max Baucus of the Senate Finance committee have professed to want—there are still “centrist” Democrats like, um, Max Baucus of the Senate Finance committee to contend with.

Just what does “centrist” mean, anyway? How did the “center” become “Somewhere between 68% of the American people and a handful of healthcare industry executives”? Unless perhaps we’re measuring center in dollars to spend. Then, perhaps, the health care industry can be balanced by a sizable majority of the American people.

The multiple meanings of the word actually might help shed some light on the politicians who claim it. The implication is that the center is somewhere between the left and the right on any given issue. The trouble being, the center is not some well-defined point in political ideology. It shifts as the public shifts its opinion. Right now, for instance, we have a popularly-elected Democratic president who still enjoys majority support in the polls even though by nearly any measure he is several steps left of where the previous president was, ideologically speaking. The center has shifted. Politicians who try to straddle the political fence between Democrats and Republicans in Congress do not represent some exact median point in the debate when there are 60 Democrats in the Senate and 40 Republicans.

But by threatening to sacrifice desperately needed reform—remember those 45 million uninsured people?–on the altar of bipartisanship, these “centrists” have placed themselves at the center of the debate. And this, perhaps, is what they truly want: to be the kingmakers. Notice that even here I have to wonder whether or not they will go along with the truly progressive bill from the House. Katrina vanden Heuvel at The Nation noted:

The danger is that promoting the view that these conservative Democrats are somehow at the center of our politics plays into the hands of those who would like to marginalize progressives as far outside of the mainstream. (And I have no doubt K Street is advising Republicans to constantly refer to their Democratic allies as “moderate” and “centrist”.)

But in the end, these “centrists” have been elected as Democrats, and will face Republican opponents for reelection. Will it be better for them to go home to campaign claiming victory and waving a new health care bill as a triumph for their party, or go home defending their part in preserving the health insurance industry’s right to profit while their constituents go bankrupt due to lack of insurance?