- BIOETHICS FORUM ESSAY
Americans Want Health Care Reform. Really.
I’m not sure what bothers me more in the recent battle over health care reform: Republican obstructionism or Democratic incompetence. In the wake of the Massachusetts special election that made Scott Brown the first Republican Senator from the state in three decades, Republican commentators say the vote is a referendum on health care: a sign that Americans fundamentally disprove of the health care legislation that has now passed the House and Senate. But is it?
Brown ran on a claim to stop health care reform dead in its tracks, but I’m skeptical that’s the main reason he was able to pull off the upset. Perhaps his victory suggests that reform has not followed the path Americans had envisioned or that Obama and his Democrat allies have been less than stellar at selling the idea to the average American. But the driving forces behind resistance seem to have had more to do with politicking than with policy.
Martha Coakley ran a campaign in which she appeared apprehensive about shaking hands and made the ultimate insult in the state of Massachusetts: suggesting that a former Red Sox pitcher was a fan of the N.Y. Yankees. Quelle horreur! The truth is, this stuff matters in campaigns.
More significantly, the Democrats failed to mobilize their base both in the state and nationwide, and they carried themselves with an arrogance and sense of entitlement that sealed their fate. Although Coakley’s loss may say something about public perception of the Democratic Party’s current trajectory, the blame does not rest on health care reform.
In fact, I’m perplexed by the assertion that Massachusetts is fundamentally opposed to current health care legislation. The national proposal is founded upon the same “three-legged stool” that Jonathan Gruber helped establish in Massachusetts: individual mandates, subsidies, and insurance reform to establish exchanges and prevent discrimination based on preexisting conditions.
Massachusetts residents support their state’s health care system—enacted by a Republican governor and supported by Scott Brown—by a 2-to-1 margin. Similarly, a Research 2000 poll conducted on the night of the election suggests that sentiment on the national health care reform is also still solidly behind reform. Among Obama voters who voted for Scott Brown and said they opposed the health care bill passed by the Senate, 36% thought the bill does “not go far enough,” while 23% said it went “too far.”
Similar results were found on a national level in a CBS poll from January 11. And a Kaiser poll released today suggests that although Americans are divided on health care reform, support increases when people are told what’s in the reform, such as tax credits to help small businesses provide insurance to employees, insurance exchanges, and a ban on insurance companies denying coverage because of preexisting conditions. Only so much can be inferred from a few polls, but they suggest that Democrats and independents who voted for Scott Brown in Massachusetts did so not for fear of overreaching government in health care; perhaps they wanted even more ambitious reform.
I have followed every twist and turn of health care reform over the past six months, and I will be the first to admit that it’s nauseating. I don’t blame the public for being cynical. This has been the emblematic case of legislative sausage-making, exacerbated by archaic legislative rules and procedures such as the filibuster. The public is not tired of health care reform; it is tired of the partisan wars required to enact it. Both Republicans and Democrats are responsible. The Republicans have systematically obstructed legislation passage; the Democrats have failed to capitalize on their majority. The threat of filibuster has been used by both sides to bring the Democratic leadership to its knees and make concessions that threaten to deprive millions of affordable quality health care.
So what to do? Must the loss of the Massachusetts seat mean the total collapse of health care reform? Some have called for abandoning the current bill and trying instead for a stripped-down bill consisting mainly of insurance company reforms and a Medicaid expansion.
While this approach would certainly be better than nothing, as Ezra Klein suggests, it would be equivalent to removing a leg from Gruber’s three-legged stool and expecting it to still stand. Keeping insurance reforms and subsidies without an individual mandate would make insurance more accessible for those who could not afford it before, but this could lead to higher premiums as healthier individuals resist joining high risk insurance pools. The elements of reform reinforce each other and necessarily depend upon each other for success.
Today, 45 health care experts urged the House to pass the Senate bill in its current form and plan on amending it later through reconciliation riders. Some Democratic members of the House have already expressed opposition to this approach, but the Senate bill is the most progressive effort with a chance of passage. Since the Senate bill is the more conservative version, perhaps it would even draw the support of legislators who did not support the more liberal House version.
Democrats were elected to make health care reform happen. If they fail after going so far, it will go down as one of the biggest collapses of social policy legislation in this country’s history. If they can move forward—even with legislation that is less than perfect—they will bring hope to millions of Americans and be remembered for their resolve in the face of bitter adversity.
It’s the playoffs. The Democrats have brought health care reform into the red zone for the first time in decades. They can wait for the blitz or go for the touchdown. Let’s hope they make the right decision.
Published on: January 22, 2010
Published in: Health Care Reform & Policy