The Need For a Democratic Solution for Health Care

With the passage of the last several months, it has become crystal clear that Congressional Republicans will stand together in their sole capacity as a status quo supporting party, and will vote together as a block against health care reform. For the Republicans, their only agenda item will be to frame President Obama's primary domestic issue as a threat to the nation. An example of this party-wide intent has been sounded by Senator Jim DeMint of South Carolina:: "If we're able to stop Obama on this, it will be his Waterloo. It will break him."

With such hyperbole in Washington having been established as a part of the capital's political landscape, "Senate Democrats are preparing to push through health care reforms using parliamentary procedures that will allow a simple majority to prevail in their chamber, as it does in the House, instead of the 60 votes needed to overcome the filibuster that Senate Republicans are sure to mount," according to a New York Times Editorial. In other words: "If the Democrats want to enact health care reform this year, they appear to have little choice but to adopt a high-risk, go-it-alone, majority-rules strategy."

Now is clearly the time for the Democrats to use their Congressional majorities and ignore the Republican whining and push ahead by taking advantage of their superior numbers and passing the legislation themselves.

The New York Times Editorial succinctly argues: "Delay would be foolish politically. The Democrats have substantial majorities in the House and the Senate this year. Next year, as the midterm elections approach, it will be even harder for legislators to take controversial stands. After the elections, if history is any guide, the Democratic majorities could be smaller."

President Obama's attempts to make health care reform  a task shared through realistic solutions provided by both parties were level minded and fair. But without the Republicans willing to give an inch toward compromise; bipartisanism was doomed to failure from the very beginning and it is time for President Obama and Congressional Democrats to move on and legislate.

The Times Editorial suggests: "The Democrats are thus well advised to start preparing to use an arcane parliamentary tactic known as "budget reconciliation" that would let them sidestep a Republican filibuster and approve reform proposals by a simple majority.

The Democrats decision to take the reconciliation approach is full of risk. The Times explains: "Reconciliation bills are primarily intended to deal with budget items that affect the deficit, not with substantive legislation like health care reform. Senators could challenge as "extraneous" any provisions that do not change spending or revenues over the next five years, or would have a budget impact that is "merely incidental" to some broader policy purpose, or would increase the deficit in Year 6 and beyond." The most significant question to be answered is "how much of the proposed health care reforms could plausibly fit into a reconciliation bill? The answer," the Times explains; "seems to be: quite a lot, though nobody knows for sure".

The Times cites: "Knowledgeable analysts from both parties (who) believe that these important elements of reform will probably pass muster because of their budgetary impact: expansion of Medicaid for the poor; subsidies to help low-income people buy insurance; new taxes to pay for the trillion-dollar program; Medicare cuts to help finance the program; mandates on individuals to buy insurance and on employers to offer coverage; and tax credits to help small businesses provide insurance."

The Times proposes: "Even the public plan so reviled by Republicans could probably qualify, especially if it is given greater power than currently planned to dictate the prices it will pay to hospitals, doctors, drug companies and other providers, thus saving the government lots of money in subsidies."

The Times correctly points out that: "Greater uncertainty surrounds two other critical elements: new rules requiring insurance companies to accept all applicants and charge them the same premiums without regard to medical condition, and the creation of new exchanges in which people forced to buy their own insurance could find cheaper policies than are currently available."

The Times elaborates: "Republicans claim that they want to make medical insurance and care cheaper and give ordinary Americans more choices. But given their drive to kill health reform at any cost, they might well argue that these are programmatic changes whose budgetary impact is “merely incidental.” Democrats would very likely counter that they are so intertwined with other reforms that they are “a necessary term or condition” for other provisions that do affect spending or revenues, which could allow them to be kept in the bill."

The Times continues: "Nobody knows how the Senate parliamentarian, an obscure official who advises the presiding officer, would rule on any of these complicated issues. But if he were to take a narrow view and eliminate important features, it could leave the reform package riddled with holes — perhaps providing subsidies to buy insurance on exchanges that do not exist, for example. Thus there are plans afoot to use a second bill to pass whatever reforms will not fit under the rubric of reconciliation, but those would be subject to filibuster and would have to depend on their general popularity (insurance reforms are enormously popular) to win 60 votes for passage."

The Times argues that: "Another hurdle is that the reconciliation legislation covers only the next five years, while the Democratic plans are devised to be deficit-neutral over 10 years. The practical effect is that the Democrats will almost surely need to find added revenues or budget cuts within the first five years."

The Times points out: "Another Senate rule, which applies whether reconciliation is used or not, requires that the reforms enacted now not cause an increase in the deficit for decades to come, a difficult but probably not impossible hurdle to surmount."

The Times concludes: "Clearly the reconciliation approach is a risky and less desirable way to enact comprehensive health care reforms. The only worse approach would be to retreat to modest gestures in an effort to win Republican acquiescence. It is barely possible that the Senate Finance Committee might pull off a miracle and devise a comprehensive solution that could win broad support, or get one or more Republicans to vote to break a filibuster. If not, the Democrats need to push for as much reform as possible through majority vote."