Healthcare Reform

That Senate vote will push Nancy Pelosi and the House Dems toward the right. That’s because it will embolden conservative and Blue Dog House Dems to threaten to vote against the far stronger bill that’s already emerged from House committees — which, in contrast to the Senate Finance bill, includes a public option, an employer mandate, significant expansion of Medicaid, and larger government subsidies to others with lower incomes. Pelosi knows she can’t get a single Republican vote, so has to count on the support of at least 218 out of 256 Democrats. That means winning over at least 38 conservatives and Blue Dog Dems — many of whom were elected from swing districts and some of whom face strong Republican challengers in 2010. With Baucus’ bill gaining momentum, or perhaps already having been passed, the conservatives and Blue Dogs in the House will demand a bill that’s closer to it. House progressives will put up a fight but there’s little question that the emerging compromise will be to the right of where the House is right now.

The two bills then go to a reconciliation committee where the White House can put some final touches on it before it goes back to the two chambers for a final vote. The White House likes this scenario because it keeps private insurance companies, Big Pharma, and the AMA from bolting. It enables the president to call the resulting bill “bipartisan,” and to claim that it marks real reform. And maintains the possibility of Republican support for financial reform and environmental legislation next year.

Scenario Two: If Snowe decides not to sign on, history moves in a very different direction. Most important, the Senate Dems know they won’t possibly have 60 votes they need. So they’ll have to say goodbye to bipartisanship — perhaps even farewell to Nelson, Landrieu, Webb and Bayh — and bundle healthcare reform into a “reconciliation” bill that can pass with 51. This new goal post strengthens the hand of Senate progressives on the Finance Committee, like Rockefeller. It also gives more weight to the version of healthcare reported out by the Senate Health, Education, Labor, and Pension committee — which includes a public insurance option, employer mandate, and more generous subsidies to the poor and lower middle class. Hence, the bill that goes to the Senate floor is much more progressive, and the final Senate’s vote (with 51 votes) better reflects the values of the Democratic base.

This Senate vote, moreover, gives more momentum and legitimacy to the House version of healthcare — which also includes the public option, employer mandate, broader Medicaid coverage and more generous subsidies to the lower middle class. That Senate vote thereby reduces the power of House Blue Dogs and conservative Dems to influence the bill that goes to the House floor. It also enables Pelosi to say to them: It’s either this or nothing. If you vote against this bill you’re voting against healthcare reform. The more progressive Senate bill, plus the stark choice Pelosi poses, garners enough votes from the conservative and Blue Dog Dems to pass a strong bill.

The White House doesn’t like this scenario because the use of a reconciliation bill in the Senate poisons relations with Republicans and risks their support for financial reform and cap-and-trade. It may even make it more difficult for Obama to rely on Republican support for more troops in Afghanistan. But as we move into the gravitational pull of the 2010 midterms, congressional Republicans won’t support Obama anyway, on anything. And remember, George W. Bush used reconciliation early in his first term to enact his huge tax cuts, mostly for the very wealthy. It’s a tried-and-true strategy.

I don’t know about you, but I’m hoping the senator from Maine votes no next week. If she does, America has a fighting chance of getting real healthcare reform.

The issue is now headed for the Supreme Court (another appellate court has upheld the law’s constitutionality) where the prognosis isn’t good. The Court’s Republican-appointed majority has not exactly distinguished itself by its progressive views.  

Chalk up another one for the GOP, outwitting and outflanking the president and the Democrats.

Remember the healthcare debate? Congressional Republicans refused to consider a single-payer system that would automatically pool risks. They wouldn’t even consider giving people the option of buying into it.

The president and the Democrats caved, as they have on almost everything. They came up with a compromise that kept healthcare in the hands of private insurance companies.

The only way to spread the risk in such a system is to require everyone to buy insurance.

Which is exactly what the two appellate judges in Atlanta object to. The Constitution, in their view, doesn’t allow the federal government to compel citizens to buy something. “Congress may regulate commercial actors,” they write. “But what Congress cannot do under the Commerce Clause is mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die.”

Most Americans seem to agree. According to polls, 60 percent of the public opposes the individual mandate. Many on the right believe it a threat to individual liberty. Many on the left object to being required to buy something from a private company.

Had the president and the Democrats stuck to their guns during the healthcare debate and insisted on Medicare for all, or at least a public option, they wouldn’t now be facing the possible unraveling of the new healthcare law.

After all, Social Security and Medicare — the nation’s two most popular safety nets — require every working American to “buy” them. The purchase happens automatically in the form of a deduction from everyone’s paychecks. 

But because Social Security and Medicare are government programs they don’t feel like mandatory purchases. They’re more like tax payments, which is what they are — payroll taxes.

There’s no question payroll taxes are constitutional, because there’s no doubt that the federal government can tax people in order to finance particular public benefits.

Americans don’t mind mandates in the form of payroll taxes for Social Security or Medicare. In fact, both programs are so popular even conservative Republicans were heard to shout “don’t take away my Medicare!” at rallies opposed to the new healthcare law.

Requiring citizens to buy something from a private company is entirely different. If Congress can require citizens to buy health insurance from the private sector, reasoned the two appellate judges in Atlanta, what’s to stop it from requiring citizens to buy anything else? If the law were to stand, “a future Congress similarly would be able to articulate a unique problem … compelling Americans to purchase a certain product from a private company.”

Other federal judges in district courts — one in Virginia and another in Florida — have struck down the law on similar grounds. They said the federal government has no more constitutional authority requiring citizens to buy insurance than requiring them to buy broccoli or asparagus. (The Florida judge referred to broccoli; the Virginia judge to asparagus.)

Social Security and Medicare aren’t broccoli or asparagus. They’re as American as hot dogs and apple pie.

The Republican strategy should now be clear: Privatize anything that might otherwise be a public program financed by tax dollars. Then argue in the courts that any mandatory purchase of it is unconstitutional because it exceeds the government’s authority. And rally the public against the requirement. 

Remember this next time you hear Republican candidates touting Paul Ryan’s plan for turning Medicare into vouchers for seniors to buy private health insurance.

So what do Obama and the Democrats do if the individual mandate in the new healthcare law gets struck down by the Supreme Court?

Immediately propose what they should have proposed right from the start — universal healthcare based on Medicare for all, financed by payroll taxes. The public will be behind them, as will the courts.