Every day that goes by without a vote in the House or Senate on universal healthcare makes it less likely that major reform will occur, because (1) opponents have more time to stir up public anxieties about it; (2) Democrats up for reelection next year come ever closer to the gravitational pull of the midterms, and grow increasingly worried about voting for a bill that could be a political liability in a year when unemployment may well reach double digits and the electorate is restless and unhappy; and (3), as a result of the first two, proponents increasingly have to rely for support and cover on industries like Big Pharma and insurance, as well as physician specialists and equipment suppliers, none of whom have any interest in fundamental reform but all of whom see possibilities for making more money out of whatever bill emerges.
In other words, next fall we might get something called "universal health insurance" that still leaves millions of Americans uninsured and doesn't substantially slow the meteoric rise of healthcare costs. That would be a tragedy.
What should be done now to avoid this?
First, the House must enact a bill before August recess even if the Senate is unable to -- and the House bill should include the four key elements that have already emerged from House committees: (1) a public plan option, (2) a mandate on all but the smallest employers to provide their employees with health insurance or else pay a tax or fee (so-called "pay or play"), (3) a requirement that every individual and family buy health insurance, coupled with subsidies for families up to 300 or 400 times the poverty level in order to make sure it's affordable to them; and (4) a small surtax on the top 1 percent of earners or families to help pay for this subsidy ("tax the wealthy so all Americans can stay healthy.")
Second, the President must tell Congress in no uncertain terms that all four elements are necessary. I believe he should also signal his openness to capping the amount of tax-free healthcare that individuals or families may receive from employers -- so long as the cap does not erode the tax-free benefits of individuals or families in the bottom 80 percent of the earnings distribution. This is the only funding mechanism that may be able to garner sixty votes in the Senate, and the only one that the Congressional Budget Office has so far said would temper the rise in long-term healthcare costs.
Third, the President should make clear to Big Pharma, private insurers, and other interest groups now supporting the effort that the final bill must contain mechanisms for forcing them to come up with the cost savings each has promised. Otherwise, those savings cannot be assumed -- and they won't be "scored" by the Congressional Budget Office -- thereby making it difficult for wavering members of Congress to vote for the bill.
Fourth, the President should commit to visiting, during the recess, all states of wavering Senate Democrats and even a few moderate Republicans (read Maine), in order to take the case for universal healthcare directly to their constituents. He or the Vice President and cabinet members should do the same in the congressional districts of all Blue Dog Democrats and other wavering House Democrats.
Finally, you, dear reader, must contact your senators and representatives and explain why you want genuine reform -- incorporating the four elements listed above. Mobilize and energize others to do the same, especially residents of Blue Dog states, including Montana, where Senate Finance Chief Max Baucus resides. And if you're able and willing I'd urge you to descend on Washington the moment Congress returns from recess. There is nothing quite as persuasive to a member of Congress as a real live constituent demanding real reform.