We are only a few days away from a reconvening of Congress and resumption of work toward, among other things, a health-care reform bill. We need to talk. This may take awhile.
The August recess has been filled with toxicity on the issue — and not just from critics of the Obama Plan which, at this late date, has not yet been fully defined. Senators and Members of Congress will return from recess with worse polarization existing than before they left.
Political and media supporters of Obama would like us to think that congressional health forums this month have been fractious and sometimes angry because of false depictions of Obama's and Democratic congressional health proposals by villains ranging from Sarah Palin to Rush Limbaugh to Glenn Beck to "right-wing extremists" to greedy insurance companies. Critics, for their part, have focused on the public costs and government controls inherent in the plans, often grossly exaggerating their statist and socialist implications. House Speaker Nancy Pelosi is their favorite poster girl.
President Obama has not helped his cause with a series of public appearances in which he often has offered his own misrepresentations or attempted to shift the subject from the substantive content of his and congressional proposals to the alleged misdeeds of insurance companies. It was painful to watch Obama attacking critics Friday at a Montana town hall during which Senate Finance Committee Chair Max Baucus, attempting to develop a bipartisan health bill, sat grimly on-stage nearby.
The White House has now renamed health-care reform as "health-insurance reform" in an attempt to frame debate as an argument between publicly-interested reformers and unpopular (according to White House polling data) insurers. Former President Bill Clinton, newly popular after his help in releasing hostages from North Korea, has been drafted into the effort to demonize insurers and is out on the stump doing so. Critics, on their side, have focused on the omission from legislation of any tort reform and demonized equally unpopular trial lawyers.
How did it come to this?
For openers, it was never in the cards that a remake of a huge part of the American economy — and one vital to the well being of most citizens — could be framed and legislated easily.
Since 1965 passage of Medicare and Medicaid, a number of attempts have been made to make major changes in our health-care system. The most recent, and successful, was President George W. Bush's proposal for a Medicare drug benefit, passed with bipartisan support. The most notable and unsuccessful was the 1994 Clinton effort, which had to be withdrawn because it lacked even Democratic congressional support. President Lyndon Johnson, seeking passage of Medicare and Medicaid, took great care to generate "consensus," which he treated as a precious concept, in undertaking fundamental health-policy change. The Clinton bill, by contrast, was developed behind closed doors by like-minded private task force members in a process which guaranteed polarization.
White House chief of staff Rahm Emanuel, an alumnus of the Clinton White House, drew the wrong lesson from the 1994 debacle. Rather than centering formulation of health legislation in the White House and executive branch, while drawing in Congressional and private-sector leaders for consultation, he concluded that content of the legislation should instead be left to Democratic committee chairs in House and Senate. Obama would campaign for the general concept of health-care reform but leave the details to Hill Democrats. Afterward, when actual legislation evolved, Obama could make it his own — or reject those parts he did not like.
That is what has happened. Obama is presently out there advocating "reform" but without any bill which is truly his own.
Meanwhile, in the House, Speaker Pelosi has responsibility for melding three committee-passed bills into one which will come to a vote on the floor. She has been in intensive negotiations with some 70-75 moderate Democrats, who want less costly and intrusive legislation, and an even larger number of progressive/liberal Democrats who want no compromise on such issues as the establishment of a public entity to compete with private insurers. In the Senate, the main game is Sen. Baucus' continuing attempt in the Finance Committee to produce legislation which can gain even a few Republican votes. The Obama White House "has not been helpful" (Baucus' words) because it has sent changing signals to both Senate and House Democrats on those provisions which it will or will not accept — especially regarding financing mechanisms.
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