Democrats will push through health care finance reform this year because the political damage from failing to do so is greater than the risk of angering opponents.President Obama put health care reform as a high priority because he knows that escalating costs and the financial carnage faced by the uninsured and underinsured are intolerable.
Bankruptcies created by medical debt cause people to lose homes and hope.
The looming insolvency of Medicare and escalating premiums of those who are insured are political nightmares for Democrats.
Perhaps most important from a political perspective, the cost to business of employer based insurance keeps American products at a financial disadvantage relative to foreign competitors whose health coverage is nationalized. This competitive disadvantage makes economic recovery anemic and job growth difficult.
What is going on behind the scenes in Washington is anybody's guess, but here's mine.
The president believes he can push legislation through the reconciliation process, though doing so would likely end the myth of bipartisanship he continues to foster.
So the president courts blue dog Democrats and an occasional Republican, hoping to be able to stop a filibuster and leave reform to an up or down vote he would win.
The reconciliation process, however, is intended mainly for legislation that is primarily about budgets, and it is not clear (to me at least) how the process can be applied to legislation that is primarily about health care issues, albeit with major budget implications.
President Obama knows that some of the decline in polling numbers regarding his management of health care reform is coming from the dissatisfaction of progressives. But progressives won't vote for a Republican in 2012. The president also knows that he won't lose the vote of senior citizens, even those scared nearly to death by talk of death panels, as long as Medicare remains intact and no one has been put to death. By the time mid-term elections come around, the scare over death panels may even haunt Republicans who have gone to the fear mongering well a few times too often. Anybody who would still believe the death panel nonsense was never a Democrat vote anyway.
President Obama is altering his statements about health care reform to more carefully reflect what is being reformed. It is not primarily health care but the way we pay for health care that needs reform. Sure, there should be electronic records and evidence based practices. But it is the employer based health insurance system that presents the most difficulty because people lose their coverage when they lose or change their jobs. And as people age, guaranteed continuation of coverage becomes problematic because of pre-existing conditions.
So the president is gently shifting focus away from health "care" reform and onto health "insurance" reform, in part because many people dislike insurance companies about the same as they dislike government. In addition, the president knows that there are lots of votes among middle-aged Americans who are not yet eligible for Medicare but acutely aware that they are vulnerable to the whims of an insurance company that decides to terminate their coverage.
President Obama is also parsing his language carefully about the public option, saying through spokesmen that he wants a system that establishes true competition among insurance companies. Though he may believe that the public option is the best way to achieve competition on a nation-wide basis, he could end up accepting alternatives that result in competition, such as coops. Health and Human Services director Kathleen Sebelius said that the president would consider such an alternative.
Some Senate Republicans have also indicated a willingness to consider them, but others consider non-profit coops subsidized by the Federal government as creating an unfair advantage over private insurance companies.
Regardless of the merits of the coops, the political advantage for the president is that he could accept such a compromise, pass the legislation, call it bipartisan, quell the fears of seniors, placate the progressives and hold or gain ground in the mid-term elections. If the coops fail to provide the competition needed to bring insurance rates down, he could return to Congress, perhaps with a stronger voting bloc, and pass stronger legislation.
As the president has indicated, failure on health care (financing) reform is not an option. It is not an option from either an economic or societal perspective. And that means it is also not a political option.
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