Two Parts To The Health Care Reform Debate

In essence, any major public debate has two separate yet linked dimensions. Space is filled by considerations of legislative politicking; counting votes, in other words. Very often these votes hue to party lines, ideological preferences, and various coalitions of legislators, are formed in the committee stage (which is why floor debate is usually quite pointless; once a committee has done its work, the floor debates usually are nothing more than an exercise in ensuring either passage or defeat, trying to swing one or two members this way or that). The other dimension, the actual policy and its effectiveness (or lack thereof) is usually relegated to the staff of individual Senators or the committee responsible for various pieces of legislation. For this reason, unfortunately, the two parts of public debate are very often separate, going in their own directions without referencing one another all that much.

As we get the massive health care reform issue rolling (Sisyphus is no longer pleased, I think), we are witnessing the outlines of this very common occurrence. Matt Yglesias sums up this frustration very nicely.

The big problem, politically speaking, with health care is that you basically have people on the left arguing both sides of the question. On the one hand, insofar as your plan is “big government” that’s left-wing. But insofar as your plan is expensive, that’s also left-wing. Which is because people normally think of big government programs as expensive. But when it comes to health care, heavy-handed government intervention is actually way cheaper than private sector alternatives. Consequently, every time you try to make the plan more “moderate” by, for example, curbing the influence of a public option you actually wind up making the plan more “left wing” by needing to raise more taxes. And if you want to make the plan cheaper, while still actually achieving its goals, then you need to make it more left-wing not more moderate. But in the United States, ideological correctness and special interest politics prevents us from admitting this.

The chart accompanying this piece, as well as several other studies of health care expenditure per capita across the industrialized world, make a point that is worth pondering: It is far less expensive, over all, to have a single-payer, publicly-funded system than any alternatives being offered.

Another part of this whole politics-policy divide that is actually infuriating is this kind of thing, also reported by Yglesias:

After reading Volsky and Cohn on the Bipartisan Policy Council health reform plan put together by former Majority Leaders Howard Baker (R-TN), Tom Daschle (D-SD), Bob Dole (R-KS) and George Mitchell (D-ME) I feel, well, kind of “eh” about it. This is not a great plan, but it would be better than the status quo. It’s about what you’d be looking for from a bipartisan compromise, in other words. Personally, I’d like to think that overwhelming progressive electoral victories would result in some juicier fruit than this, but the fact of the matter is that a lot of the Democrats in the Senate appear to not have particularly progressive convictions.

Which I think leads to the question, how bipartisan is this really? Howard Baker and Bob Dole are nice, but how about some Republicans currently serving in the United States Senate?

If you are too young to remember, Howard Baker was Senate Majority Leader during the 1980's. He retired from the Senate after not seeking re-election in 1984. Bob Dole, you may recall, is also no longer in the Senate. While George Mitchell and Tom Daschle are probably nice guys (for the most part), they were also pretty ineffective Majority Leaders when the Democrats held thin majorities in the upper house. Neither, of course, currently hold elective office (although Mitchell is a special envoy for Pres. Obama).

I think it is important to note, as Bob Cesca does, that many of the major players in this debate are major recipients of campaign donations from the health insurance industry. One of the biggest, Max Baucus of Montana, has received over $2,000,000. While political ideology may be an important factor in this debate, what is driving the Senate away from the overwhelmingly popular public option is filthy lucre, pure and simple.

While I understand Pres. Obama will be holding a live discussion this weekend on health care reform, my own wish is similar to that of many other supporters both of the President and serious health care reform - get out there, speak loudly, often, clearly, and in detail, on what kind of reform you want, and how quickly you want to get it done. The public is behind you, but the health insurance lobby has far more cash at its disposal, and therefore more influence.

While much of the immediate debate sounds eerily familiar to the 1990's attempt to address the issue, there are several things that give me at least a dim glimmer of hope. First and foremost is the simple reality that the Republicans are no longer ascendant in Congress. While they and more conservative voices certainly have the bully pulpits of traditional media, they are no longer the only, or even the biggest, game in town. David Broder may nourish a seriously stiff jones on the whole Baker/Dole/Daschle/Mitchell business, but they aren't in the Senate anymore. In other words, who cares what they think?

We also have a President who is still, despite all the grumbling of the press and conservative yakkers, wildly popular with the American people. While I believe the poll data that emerged yesterday pointing to "concern" over federal spending, once the point is driven home that a public plan would be far cheaper overall than any other option currently under consideration, I believe the debate will shift back toward a proposal the country supports.