The Senate Democrats’ health-care deal is remarkable in many respects. President Obama praised them on Wednesday for producing "a creative new framework" to provide coverage to uninsured Americans without relying on a government insurance option. And well he should. Its creativity is the most impressive thing about it. Somehow the 10 Democrats, evenly divided between pro-and anti-public option going in—came out without a public option but still managed to make people who insisted on the need for one happy. (If Paul Krugman is happy, I’m happy.) It’s not exactly clear how it came about. Either liberals were so beaten down by how badly things have been going for them since Obama’s inauguration or because the public option was merely shorthand for covering as many people with affordable insurance as the system would permit. In any case, the conservatives and insurance companies got to declare “victory” and the liberals got what they wanted anyway. A symbolic victory for conservatives and private industry and a substantive one for liberals? When was the last time anything like that happened?
A symbolic victory for conservatives and private industry and a substantive one for liberals? When was the last time anything like that happened?
Nothing proves the cliché that “where you stand depends on where you sit” better than Barack Obama’s attempt to reform the U.S. health-care system. When he began, U.S. citizens had, by virtually every measure, the most expensive, least efficient, and most wasteful health-care system in the advanced industrial world. By the time Congress is finished, they still will, but it will probably be a little bit better. According to the terms of the Senate compromise hammered out by Harry Reid and his friends Tuesday night, nobody’s going to get a “public option” but people over 55 are going to get a chance to buy into Medicare, or something like Medicare. And kids under 18 are going to get their coverage extended. And other people will be able to buy health insurance from nonprofit entities formed by for-profit companies tightly regulated by the Office of Personnel Management. Or something. Really, if you’re not a professional policy wonk, it’s enough to send you to a private, no-insurance-taken headache clinic just to think about it.
What’s important about it is less the details than the fact that it is happening at all. The Democrats did something about a really big problem facing the country. Most people, including probably most Democrats, figured that had become impossible. And they had good reason. Leave aside that the only word upon which that Republicans can agree these days is “no.” This was a bill with a list of powerful potential enemies thicker than Tiger Woods’ little black book. The AARP; the AMA; Big Pharma; the insurance industry, to say nothing of consumers who are themselves easily divisible into warring constituencies: liberals, “centrists,” conservatives, young and old, rich, poor and in the middle; people who won’t trust the government to do anything, etc. For a while, the left was promising to kill this bill if it turned out to be insufficiently progressive. And Martha Coakley just got the nomination for Teddy Kennedy’s seat in Massachusetts, rather amazingly given that health-care reform was the cause of Kennedy’s career, by promising to oppose any bill that contained the restrictive abortion language passed in the House and engineered by fierce choice proponent Nancy Pelosi. (Gosh this is confusing.)
• Tunku Varadarajan: The Senate’s Scary Health-Care Deal• Matt Miller: Liberals, Rejoice!Remember, nothing is easier than stopping something in our political system and doing something is always riskier than doing nothing. You only need 40 votes to shut down debate and Republicans almost always try to do so. So even if this compromise totally sucks from the standpoint of what needs to be done to bring us to the level of any self-respecting European nation, the fact that it looks like it’s happening remains rather jaw-dropping. Teddy Roosevelt proposed a national health-care program in the Bull Moose platform of 1912, but lost the election to Woodrow Wilson, who had no interest. Harry Truman made it a priority in 1948, but had no power to pass it with a Republican Congress. Bill Clinton could have passed something in 1992, but screwed it up beyond belief by 1994 and lost the Democrats their congressional majority in the process. But Barack Obama, somehow, looks like he’s going to make it work.
Of course it still may not happen. Reid does not have the votes yet. Medicare pays much lower rates than do private insurers and so doctors and hospitals may turn against it.
Joe Lieberman, the senator from Hartford’s insurance industry—yes, the man does have a party—has lost his hobby horse of protecting his campaign contributors from government-organized opposition but is not without resources in seeking a pretend-principle to oppose a plan that, coincidentally, happens to mirror the plan that he and Al Gore put forth in their 2000 presidential campaign Otherwise, Sens. Nelson and Landrieu or Snowe or Lincoln or some combination of two of those people needs to be willing to vote to take this thing to a vote. It’s hard to believe that they will shut down this historic opportunity over some narrow parliamentary issue, but American politics today is nothing if not hard to believe.
Barack Obama took a helluva risk when he decided to make health-care reform the centerpiece of his administration’s first two years. Economic reform would have been smarter and easier. All of the Clintonites tried to warn him off. Republicans swore he was trying to murder old people on his way to creating a Nazi/Soviet/Acorn state. Millions poured into the coffers of potential opponents from those whose profits appeared threatened. “Harry and Louise” came back to life, together with the equally implausible Betsy McCaughey, who, together with William Kristol, deserved a lion’s share of the “credit” for killing health care back in 1994. (Whether in panic or in tribute I cannot say, but Kristol’s Weekly Standard Web site managed to throw up eight separate posts in the immediate aftermath of the announced compromise, alternately mocking the notion that such a bill might pass and warning of imminent apocalypse if it did.)
One impressive statistic is that despite the complexity of the issue, the considerable impact it is likely to have on individual lives, and the media fascination with the scare tactics of “the Commie/Nazis are coming” right-wing, a solid majority of Americans wants Congress to pass a health-care reform bill, preferably with a public option. And it looks like they are actually going to get it. And that, alas, is when things will really get complicated….
Eric Alterman is a professor of English and journalism at Brooklyn College and a professor of journalism at CUNY Graduate School of Journalism. He is the author, most recently, of Why We're Liberals: A Handbook for Restoring America's Important Ideals.