Senate healthcare bill: Time to kill it?

Is reform without public option worth it? Markos, Ezra Klein, Paul Krugman, Howard Dean and others weigh in

By Thomas Schaller
December 15, 2009 10:16PM (UTC)
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Sen. Joseph Lieberman, I-Conn., talks to reporters after leaving a Democratic caucus outside of the Senate Chamber on Capitol Hill in Washington, Wednesday, Dec. 9, 2009.(AP Photo/Harry Hamburg) (Associated Press)

Is the watered-down, no-public-option healthcare reform bill worth saving? Or should it be killed? That is the question on everyone's lips today.

By Twitter, Markos of Daily Kos let it be known where he and many progressives stand on the issue: "Insurance companies win. Time to kill this monstrosity coming out of the Senate."


That specific tweet, and the broad sentiment that underlies it, is generating quite a bit of response.

On MSNBC's "The Ed Show," Joan Walsh derides Joe Lieberman but compares progressives who want to kill the entire Senate bill to people who voted for Nader over Al Gore in 2000.


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The WaPo's Ezra Klein writes on his blog:

The core of this legislation is as it always was: $900 billion, give or take, so people who can't afford health-care insurance suddenly can. Insurance regulations paired with the individual mandate, so insurers can't discriminate against the sick and the healthy can't make insurance unaffordable by hanging back until the moment they need medical care. The construction of health insurance exchanges so the people currently left out of the employer-based market are better served, and the many who will join them as the employer system continues to erode will have somewhere to go.

That's all policy. And as I spent yesterday arguing, it has a tendency to overshadow the lives in the balance. You can choose your estimate. The Institute of Medicine's methodology says 22,000 people died in 2006 because they didn't have health-care coverage. A recent Harvard study found the number nearer to 45,000. Since we talk about the costs of health-care reform over a 10-year period, may as well talk about the lives saved that way, too. And we're looking, easily, at more than a hundred thousand lives, to say nothing of the people who will be spared bankruptcy, chronic pain, unnecessary impairment, unnecessary caretaking, bereavement, loss of wages, painful surgeries, and so on.

A lot of progressives woke up this morning feeling like they lost. They didn't. The public option and its compromised iterations were a battle that came to seem like a war. But they weren't the war. The bill itself was. When liberals talked about the dream of universal health-care insurance 10, 20 and 30 years ago, they talked about the plight of the uninsured, not the necessity of a limited public option in competition with private insurers.

Salon reached out to others with strong opinions on this issue, and we will be updating this post as reactions come in, so stay tuned.

In contrast to Klein, Stephanie Taylor, co-founder of Progressive Change Campaign Committee, told us:


The "Joe Lieberman Senate Bill" is ugly. Democrats stand on the verge of ushering in a world of nearly unregulated mandates, in which we're all forced by the state to hand over our money to failed private monopolies, with no cost control in return. Without a public option and no hope of expanding Medicare coverage, this bill is not worth supporting.

We got to this point due to a complete failure of leadership by President Obama--who chose to negotiate with out-of-touch senators instead of rallying their own constituents against them. It's also a failure of leadership by Harry Reid, who failed to exert any leverage over Joe Lieberman--by threatening to take away his committee chairmanship or use reconciliation to make his vote irrelevant.

When Democratic leaders refuse to fight, they can't then ask progressives to cave with them. The Progressive Change Campaign Committee is continuing to fight for the best health care bill possible, and we're intent on holding Democrats' feet to the fire. But we need to think very seriously about whether there will be a moment when it is clear that the bill does more harm than good--we need to be prepared to kill the bill.

Part of being a great negotiator is being able to walk away.

 Jonathan Cohn, author of Sick and writer for the New Republic, more closely echoed Klein's view:

Is health care reform without a public option still worth passing? Unequivocally, unambiguously yes.

The case for is simple and straightforward: 30 million additional people, maybe more, will have health insurance. Many more who have insurance will see their coverage become more stable. The ability of insurers to exclude people based on pre-existing conditions will diminish significantly, if not disappear. And that's on top of a host of delivery reforms which should, in combination, help make medical care less expensive over time. The bill could be much better, for sure, but to argue that it's worse than nothing you have to make the case that nothing will somehow lead to more progress in some reasonable frame of time.

I don't see that. Failure to pass health reform won't lead to a progressive revival or resurgence. It will cripple the Democrats, hand the Republicans more political power, and likely to send health care reform into hibernation for another ten to twenty years. It's theoretically possible we could get a better reform at that point. But the historical trend is in the opposite direction. Every new effort is a less ambition version of the old one. Meantime, millions of more people would suffer.

Pass this bill now. Improve it later. That's the way we do things in America, for better or for worse.

Paul Starr, c0-founder of the American Prospect and no liberal he, seems to be squarely in the Klein/Cohn camp:

The moment of decision on health-care reform is arriving for progressives in Congress. Some of them have insisted they will refuse to vote for any bill without a public option, and that is now the only bill that has any chance of passing. If they hold to their position, the most significant social reform on behalf of low-income Americans in 40 years will go down to defeat.

It should hardly be surprising that we have come to this point. The requirement for 60 votes in the Senate to pass ordinary legislation was always going to empower the most conservative members of the Democratic caucus or the few moderate Republicans who might support a bill. For a while this past week, it seemed as though a provision to allow 55- to 64 year-olds to buy in to Medicare might provide an acceptable alternative to the public option and secure the 60th vote for the bill. But when both Joe Lieberman and Olympia Snowe said they wouldn't support a Medicare buy-in, that hope dissolved.

None of this, however, affects the central provisions of the legislation, which would extend health coverage to an estimated 33 million of the uninsured, raise standards of protection for millions whose coverage is limited, eliminate some of the most hated abuses of the insurance industry, and create a new system of insurance exchanges that would enable people who buy policies individually or through small groups to get new choices and better prices for coverage....

Strategists will argue about whether it ever made sense to include a public option in the bill, ...[b]ut the attention lavished on the public option meant that pressure from the left did not come to bear on other provisions of the legislation such as the slow timetable for implementation (under the Senate bill, most of the extension of coverage would not occur until 2014). The danger now is that some liberals in Congress may not be able to shift gears and vote for something they earlier pledged to oppose. Some of the Democratic base may also become demoralized about reform because it lacks a provision they were mistakenly told was essential.

Frequent Salon contributor Ed Kilgore, ever the stragetist who can see the whole board, doesn't so much take a side as lay out five options progressives have in front of them:


...the fact remains that there are only 58 reasonably assured votes for cloture on the recently negotiated Team of Ten "deal" for health care reform. Assuming Ben Nelson can be brought aboard without highly divisive concessions on the abortion issue, that still leaves one vote to be secured from a universe of just three senators: Lieberman, Snowe and Collins. So what are the options left to the White House and the Democratic congressional leadership?

(1) Forget about Lieberman and go after Snowe and/or Collins. It would obviously be satisfying to most Democrats to deny Joe Lieberman the opportunity to be King of the Senate and Arbiter of Health Reform, or more to the point, the chance to screw up or kill the legislation down the road....

(2) Give Lieberman what he wants and then fix the legislation later. The key argument here is that the very items Lieberman is objecting to--an option for some younger Americans to buy into Medicare, and any sort of public option--are budget savers which could without question be added later (say, next year) via the budget reconciliation route, which only requires 50 votes....

(3) Threaten Lieberman with loss of his seniority unless he votes for cloture. Without question, it was a major mistake for the Democratic Caucus to allow Lieberman to maintain his seniority after the 2008 elections without an ironclad pledge that he would support the Caucus on all procedural votes, including cloture votes....

(4) Reframe the bill to use reconciliation. This is the strategy many progressives have been urging all along, for the obvious reason that it gets rid of the need for more than 50 Senate votes and also would make it vastly easier to craft a Senate bill that's close enough to the House bill to avoid friction in a House-Senate conference....

(5) Go back to the drawing board. Before resorting to any of the above unsavory options, health reform supporters will undoubtedly make some effort to devise yet another compromise that can obtain that 60th vote without losing existing supporters....

Maybe I'm missing something, but these seem to be the options at present, and none of them are particularly good. We may be once again at a crucial juncture where progressives--and most of all, the President--simply have to decide what percentage of a loaf is acceptable.

According to Greg Sargent, former DNC chair Howard Dean reportedly says kill it:

In a blow to the bill grinding through the Senate, Howard Dean bluntly called for the bill to be killed in a pre-recorded interview set to air later this afternoon, denouncing it as “the collapse of health care reform in the United States Senate,” the reporter who conducted the interview tells me.

Dean said the removal of the Medicare buy-in made the bill not worth supporting, and urged Dem leaders to start over with the process of reconciliation in the interview, which is set to air at 5:50 PM today on Vermont Public Radio, political reporter Bob Kinzel confirms to me.

The gauntlet from Dean — whose voice on health care is well respsected among liberals — will energize those on the left who are mobilizing against the bill, and make it tougher for liberals to embrace the emerging proposal. In an excerpt Kinzel gave me, Dean says: "This is essentially the collapse of health care reform in the United States Senate. Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill.”

The incomparable Paul Krugman says swallow hard and grudgingly, but pass it: 

Ugh. It grates terribly to have the health care bill seriously weakened out of pure spite — and that’s clearly what’s happening, as Joe Lieberman demands the withdrawal of a feature he himself was advocating just three months ago.

Paul Starr — a veteran of the Clinton attempt — says that we should just pass the thing and try to fix it later. I guess I grudgingly agree — unless Lieberman demands further changes, gutting the bill. And I have a sick feeling that he’ll do just that.

But no more. On the next big challenge, financial reform, I say do it right or not at all. And we really need to talk about changing the way the Senate works; at this rate we’re well on our way to becoming a failed state.

Must-read Digby says kill it:

If this is the only chance for reform in generations, wouldn't it have made more sense to fight for a truly comprehensive bill that actually solved the problem? If you've only got one bite of the apple every couple of decades, it seems remarkably foolish not to really go for broke. To end up with a bill like this as your once in a generation liberal accomplishment is about as inspiring as a Bobby Jindal speech.

And Obama can say that you're getting a lot, but also saying that it "covers everyone," as if there's a big new benefit is a big stretch. Nothing will have changed on that count except changing the law to force people to buy private insurance if they don't get it from their employer. I guess you can call that progressive, but that doesn't make it so. In fact, mandating that all people pay money to a private interest isn't even conservative, free market or otherwise. It's some kind of weird corporatism that's very hard to square with the common good philosophy that Democrats supposedly espouse.

Nobody's "getting covered" here. After all, people are already "free" to buy private insurance and one must assume they have reasons for not doing it already. Whether those reasons are good or bad won't make a difference when they are suddenly forced to write big checks to Aetna or Blue Cross that they previously had decided they couldn't or didn't want to write. Indeed, it actually looks like the worst caricature of liberals: taking people's money against their will, saying it's for their own good. --- and doing it without even the cover that FDR wisely insisted upon with social security, by having it withdrawn from paychecks. People don't miss the money as much when they never see it. executive director and former congressional candidate Darcy Burner agrees with Digby, and suggests returning to the House's version and working from there:


There are four key questions we can use to evaluate the proposed reforms:

1. Affordable coverage for everyone: How close are we to the ideal that every American will have access to high-quality health care that they can afford?

2. Value: How much have we improved the value Americans get for our health care dollars -- so that we are healthier and get more for our money?

3. Fixing insurance company injustices: Have we reduced or eliminated the injustices caused by insurance companies when they destroy the lives of people who get sick by refusing to pay for care, or retroactively canceling their insurance?

4. Trajectory: Are we on a path towards continued improvements in all of those areas?

If we look at the current Senate proposal, the scorecard is not promising...(Editor's note: see full post for her detailed discussion of all four points she raised above)

....That's the best the Senate can do? Thanks to Joe Lieberman, it's worse than nothing.

We should fight for the House bill, which does a better job on all fronts. With some minor tweaks to ensure that women can get the reproductive care they and their doctors think they need, it's a decent bill on the right trajectory.

But if it's Joe Lieberman's bill or nothing? Kill it.

Angela Glover Blackwell, founder and CEO of PolicyLink, wrote in to Salon to share her mixed feelings about the state of the legislation:

Politics is the art of the possible. It rarely gives us everything we want -- and often it doesn't even give us what we need. The health-care debate has been a case study in compromise -- alternating between hopeful and infuriating and back again.

It's still not clear exactly what will pass muster in the Senate. The two most cost-effective and easy-to-implement solutions -- expanding Medicare and Medicaid -- are slipping out of our grasp. That is unfortunate.

But we are still left with a proposal that takes several important, relatively moderate steps toward a more insured, healthier nation. The protections against rescission and rejections for "pre-existing conditions" should help curb the most egregious abuses of the insurance industry. And subsidies for low-income people will help bring millions of struggling Americans into the health insurance system for the first time.

There are good elements to this proposal – and it seems it is as good a bill as can reasonably be passed in this Congress. This should be a proud moment for everyone who has worked tirelessly to expand care and improve the health of all Americans.

But it is also a moment of quiet sadness. Barrels of ink and countless hours have been spent crafting a bill that lacks the bold reforms we need for the long-term. We had the opportunity to transform our health-care system to ensure everyone is secure and healthy. While there is some hope the more expansive House bill will improve the overall package in conference, I fear we have missed our best chance.

The bill we expect to get will be what is possible. It just might not be what is necessary.

As is his custom, the Atlantic's Marc Ambinder doesn't advocate one way or the other, but the implication of his post is that Democrats will not have majorities by 2011 if they don't pass some form of health care, so presumably they should accommodate Ben Nelson and either Lieberman or Snowe and salvage what they can:

Here is the reality, though: the Democrats need 60 votes. They're not going to pass the insurance reforms through reconciliation. (Some blame the White House for insisting that Democrats eschew the reconciliation option.)

That means that Ben Nelson has to be accommodated on abortion, and then Joe Lieberman or Olympia Snowe has to compromise. Snowe is the more likely of the two, so, barring a change of heart, the best that Senate Democrats can do, at the moment, is probably to water down their Medicare buy-in and add a trigger mechanism to it, which will probably get Snowe's vote. Probably.

The good news for Democrats is that once they pass this bill, they can add subsidies through the much-easier reconciliation process later on. They've got several years to do so, assuming they retain their majority, which is probably not possible if they fail to pass health care.

As you would expect from him, my blog-boss Nate Silver at the other place I write,, crunches the numbers in the Senate bill relatives to the status quo and says supporting the bill is a no-brainer. You have to see his charts and analysis, which I can't reproduce here, but his key closing graphs are:


I understand that most of the liberal skepticism over the Senate bill is well intentioned. But it has become way, way off the mark. Where do you think the $800 billion goes? It goes to low-income families just like these. Where do you think it comes from? We won't know for sure until the Senate and House produce their conference bill, but it comes substantially from corporations and high-income earners, plus some efficiency gains.

Because this is primarily a political analysis blog, I think people tend to assume that I'm lost in the political forest and not seeing the policy trees. In fact, the opposite is true. For any "progressive" who is concerned about the inequality of wealth, income and opportunity in America, this bill would be an absolutely monumental achievement. The more compelling critique, rather, is that the bill would fail to significantly "bend the cost curve". I don't dismiss that criticism at all, and certainly the insertion of a public option would have helped at the margins. But fundamentally, that is a critique that would traditionally be associated with the conservative side of the debate, as it ultimately goes to mounting deficits in the wake of expanded government entitlements.



Here's how "The Ed Show" on MSNBC covered the issue:

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Thomas Schaller

Thomas F. Schaller is professor of political science at the University of Maryland, Baltimore County and the author of "Whistling Past Dixie: How Democrats Can Win Without the South." Follow him @schaller67.

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