Saturday, December 27, 2014

Will Rogers, the sequel

Internal Democratic tensions over health care

Will Rogers, the sequel

 

 

Early in the last century, humorist Will Rogers famously quipped, "I'm not a member of an organized political party. I'm a Democrat." The party has since sustained its disputatious reputation. As evidenced by the current intramural tiffs over health care reform, President Obama is arguably getting more grief from his friends than from his Republican foes.

His goal, of course, is to eventually sign landmark legislation that will, among other things, lower health care costs while extending coverage to uninsured Americans. His chief challenge is to somehow satisfy his restive liberal base while attracting enough moderate centrist lawmakers to give the reforms a bipartisan flavor. Or perhaps it's the other way around. Perhaps his chief aim is to work a compromise deal that will satisfy the moderate centrists while sufficiently mollifying restive liberals. Right now, in this early stage of sausage-making on Capitol Hill, it's tough to tell which approach is the president's priority. Growing tensions are evident.

Several episodes, over the past few days, serve as illustration.

Liberal lawmakers, buoyed by the actions of grassroots liberal groups and committed to Obama's campaign promises of sweeping change, remain adamant about giving Americans the choice of a government health insurance plan (the so-called "public option") that would compete with the private insurance companies and, in practice, ideally compel those firms to offer consumers better deals on coverage. That has been the basic pitch from senators such as Ted Kennedy and Chuck Schumer, and from the vocal liberals on the House side. But key centrist Democrats - notably, Max Baucus of Montana, who chairs the pivotal Senate Finance Committee - have serious doubts about the merits of a public option; meanwhile, there are concerns that a reform bill containing a public option would not even attract a filibuster-proof Senate Democratic majority, that it could alienate swing lawmakers in both parties and thus erase the prospects for bipartisan support. (Obama wants at least a patina of bipartisan support.)

Enter Obama's Capitol Hill fixer, Rahm Emanuel. Yesterday he freaked out the liberals in his party by suggesting, in The Wall Street Journal, that Obama might be open to compromise on the public option issue. "The goal," he said, "is to have a means and a mechanism to keep the private insurers honest. The goal is non-negotiable; the path is." Whoa, hang on: the path is negotiable? It appeared so. Emanuel then said that Obama might entertain a deal whereby the private health insurers would be given a sufficient amount of time (a grace period) to clean up their act and offer more affordable coverage to an expanded number of Americans - and if the insurers failed to do so, the government would then step in with a public health option. In other words, Emanuel suggested, a squandered grace period would "trigger" a public option.

This "trigger" idea - which Max Baucus and other moderates have been talking about for months - didn't sit well with the liberals. The 77-member Congressional Progressive Caucus sent a letter to Obama yesterday warning that a public option should be offered on day one, and that any "trigger" compromise would be a "non-starter" for many liberal lawmakers. Then they met with Emanuel and told him the same thing. He apparently said: don't worry, I still support a public option. Meanwhile, Baucus got word from Democratic leadership that a watered-down public option provision would be a deal-killer for as many as 15 Senate Democrats. Schumer himself said on CBS this past Sunday that a public option "has to be available on the first day to everybody," without giving the private insurers any grace period, and he said yesterday that Emanuel's "trigger" remarks "came as a surprise to me."

Amidst all this, Obama himself felt compelled yesterday to put out a clarifying statement, hoping to hose down the liberals. Given the fact that he was in Russia at the time - dealing with little trifles such as, oh, nuclear weapons - his decision to weigh in on the health care flap was clearly a measure of its critical importance.

Here's what he said; it requires a close reading: "I am pleased by the progress we're making on health care reform and still believe, as I've said before, that one of the best ways to bring down costs, provide more choices, and assure quality is a public option that will force the insurance companies to compete and keep them honest. I look forward to a final product that achieves these very important goals."

A cursory reading suggests that Obama was mollifying the liberals, by restating his support for a public option. A close reading suggests otherwise. He says only that the pubic option is "one of the ways" to prod the private insurers. There was nothing in that statement to suggest he will go to the mat for a public option. Indeed, in a conference call with congressional leaders last Friday, Obama assailed certain liberal groups for their latest attempts to pressure moderate Democrats into supporting the public option. During the call, Obama reportedly warned about the pitfalls of circular firing squads: "We shouldn't be focusing resources on each other. We ought to be focused on winning this debate."

What's not clear - at this point, and for the foreseeable future - is how the White House will define "winning." Is a bipartisan bill the ultimate goal, and would a public option be sacrificed in pursuit of that goal? Would liberal lawmakers accept such a deal, taking half a loaf rather than nothing? Or is there some kind of moderate/liberal compromise, some kind of public option lite - say, the creation of patient-owned health cooperatives - that could compete with private insurers and thus allow everyone to say that Obama has achieved his lower cost and expanded coverage goals? (On the other hand, the health coops that already exist have a spotty track record of holding down costs.)

And what are the odds that liberal groups will heed Obama's call for an intraparty ceasefire? Zero, apparently; they're determined to keep the heat on his left flank. Several groups have announced new TV ad campaigns, aimed at pressuring red-state Democratic senators (Mary Landrieu, Ben Nelson) into supporting the public option. Obama may be president, but he has no say in what these groups choose to do. He may be president, but he can't compel Congress to write the health care bill of his dreams; as Harry Reid said in January, "I don't work for him." Oh, the joys of majority Democratic governance. Will Rogers would feel right at home.
 

 

Dick Polman Inquirer National Political Columnist
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Dick Polman Inquirer National Political Columnist
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