The Pelosi Predicament

Hi gang, happy championship week aka Mid-winter Break Week aka prelude to March Madness aka Mr. Massa's Fifteen Minutes of Infamy.... enough nonsense. We've got important matters before us, and now is the time for all good men and women to come to the aid of their country (or this country, which is in need of aid).

As promised, I'm weighing in for what it's worth on the Health Care homestretch as Speaker Pelosi and Steny Hoyer try to count votes in the House for the so-called "reform" measure that passed the Senate on December 24, 2009. The White House is busy "going public," today in St. Louis, earlier this week in Pennsylvania, in an effort to drum up support from enough citizens to make it seem like a groundswell of genuine support for the House to pass the Senate version on the hope (and prayer) that tweaks to the Senate bill will be made via "reconciliation" aka simple-majority budget rules afterward.

So let's weigh the pro's and con's. From the Speaker's point of view, this is a tall order. The House version differed substantially in two key ways from the Senate version. First, it had a strong public option; and second, it created three new tax brackets among the rich to pay for it while the Senate bill utilizes an excise tax on so-called "cadillac" health plans, but due to Labor opposition, this wouldn't go into effect until 2018. Both bills contain mandates requiring that the uninsured purchase insurance, but the Senate bill falls short of universal coverage by some 6%. Both bills expand COBRA coverage for young people currently covered by their parents' insurance, from age 24 to 26. According to the CBO, both bills would bend the "cost curve" -- i.e., slow down the growth of Medicare and Medicaid entitlements -- though this is in dispute by a Harvard Medical School projection on the Senate bill.

From Speaker Pelosi's standpoint, you can see why this is a tough vote. Members in the House who voted for the House version would have to hold their nose to vote for the Senate version. Dennis Kucinich, who voted against the initial House version because it was not a Single-Payer system, has already said he won't vote for the Senate version. And there are currently twelve Democrats that voted for the House bill who, following Bart Stupak (D-MI) are convinced that the Senate language prohibiting publicly-financed abortions is not strong enough and are threatening to vote against the Senate bill for that reason. Kucinich has called the Senate version a huge "bailout" for the health insurance industry since it gives millions of new customers to the private providers without any real guarantee that premium costs will be controlled. The recent announcements by Iowa and California branches of Blue Cross-Blue Shield that rates will increase for some by 12% to 39% this year give support to Kucinich's view. But the White House responds by saying that the failure to act -- i.e., to continue on the course we're on -- is unsustainable. We'll be bankrupt due to the health entitlements by 2020.

Then there is the politics at stake. Failure to act would be scored politically as a victory for the Republicans, and this is a terrible precedent -- though it's not really a precedent given unanimous GOP opposition to Clinton's first budget in 1993 -- given the indefensible course we're presently on. By the same token, there is plenty to object to with these bills, though the principles for objection voiced by Republicans ("opening the door to a public takeover of health care") and by progressives like Kucinich ("it's a give-away to the insurance companies") are from parallel universes. Given the cowardly way that the Senate bill has contrived to pay for the reform -- by "binding" future Congresses to implement a tax they don't have the guts to implement -- it is hard to be enthusiastic about the Senate bill. It is possible to argue that we'd be better off by canning the reform effort now and let this play out in the 2010 and 2012 elections. It might be better, in fact, to let these elections become referenda on the issue of health care reform than to go forward with the difficult-to-describe and more difficult-to-defend monstrosity that the Senate bill has become. Indeed, it could be that this would split the Democratic party between those favoring "Medicare for all" (the preference of the Pelosi Democrats) and the "Republican-lite Democrats" who think that reform is possible without changing the for-profit insurance industry that is the moral and financial enemy of reform in the first place.

This, then, is the "Pelosi predicament." She is asked to take one for the team by whipping a vote for the Senate bill, but she has real doubts about the likelihood that the Senate bill will produce the reform needed. So, before I go on record and declare how I'd vote were I a member of the House (in the Democratic Caucus, obviously), I'll solicit the group's wisdom on how Nancy should proceed and whether he choice will prove fruitful. So, what's your verdict?