I need to start by saying that I have a lot of policy disagreements with the president about health care. I think we need single payer. I'm disappointed that the proposed public option is only open to those who don't already have health insurance. The version of the public plan originally proposed by Jacob Hacker would have covered anyone who wanted it, and would have done a lot more to control insurance costs. And despite the president's assurances, I'm worried that people without much money would be required to pay more than they could afford for the health care insurance that they'll be required to have. Senate Finance Committee Max Baucus's framework is particularly worrisome in that regard. And frankly, I think it's a bad thing that federal money can't be used to pay for abortion.
That being said, I think that it was a masterful speech by a masterful consensus builder. The word "masterful" makes me want to get out some Julia Penelope on the topic of patriarchal language, but that is a topic for a different time.
I do want to talk a little bit about consensus.
Watching the president, I was reminded of old meetings of, oh, say, the Oregon Women's Land Trust. If you've ever been part of a lesbian feminist organization that runs on consensus decision making, you will know that the US Congress has nothing on lesbian activists when it comes to getting into down-and-dirty political fights. The Senate, in particular, has rules that are very reminiscent of consensus decision making used by lesbian feminist collectives. Having a simple majority is enough to get something passed. While one person can't shut down the Senate (and I have more than once seen a single dissenter shut down a lesbian collective from taking any action), you need to have 60 votes to cut off debate in order to proceed with a bill.
By its nature, it's a conservative process. The way the Senate operates probably has most of the same advantages and disadvantages of consensus decision making. One big disadvantage is that a minority can bolix up the works and keep actions from being taken that have majority support. This is what's happening in the Senate right now. Especially after the death of Ted Kennedy, the president and the Democrats can't count on 60 votes to move forward without courting Republicans and conservative Democrats.
But the disadvantage is also an advantage. The truth is, if you have a substantial minority of the population that opposes a law that has passed, that law has much less chance of succeeding. It seems to me that the most successful movements of our times--the civil rights movements, the feminist movements--have been the most successful when campaigns to pass legislation were combined with campaigns to achieve popular support. Changing laws is not enough without changing people's hearts and minds. Sometimes the piece of legislation fails, but the change in popular attitudes that came about by fighting for it makes an enormous positive difference. I'm thinking of the Equal Rights Amendment here.
Okay, okay, I'll try to get back on track. Health care legislation is not the same as civil rights legislation, and to make a change, we do need to pass a law. I'm just trying to make the point that to pass the legislation and to have it succeed, President Obama needs to bring people together and build a broad base of support for it, including from moderate and conservative members of the population. And I think that's exactly what he succeeded in doing with his speech last night. He took the things that just about everybody agrees about, and used that as a basis for moving forward.
He gave an eloquent description of exactly how broken our current system is. How we are the only advanced democracy that doesn't offer universal health care. How people who don't have insurance--because they are self-employed and can't afford it, because they have a pre-existing condition that won't allow them to get coverage--can be just one accident or illness away from bankruptcy. How people who have insurance can find that their coverage has been dropped just when they need it the most. How we spend one and a half times more per person on healthcare per person without that making us any more healthy. How health insurance premiums are rising in cost three times faster than wages, and how this puts workers and businesses at a disadvantage. How increasing health care costs are putting "an unsustainable burden on the taxpayers."
When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid. If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined. Put simply, our health care problem is our deficit problem. Nothing else even comes close.What the president did with the first part of his speech was to demonstrate that we do have a national consensus about what is wrong with the way we pay for health care. What he did next was to address what we need to do to fix it. His strategy was to position himself as being what he always has been, a centrist.
There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada's...where we would severely restrict the private insurance market and have the government provide coverage for everybody. On the right, there are those who argue that we should end employer-based systems and leave individuals to buy health insurance on their own.(Oregon Democratic Senator Ron Wyden has also proposed a plan that would end employer-based coverage and retain a private market, and might have been surprised to hear himself classified as being "on the right," but I suppose that is also a topic for another time.)
At any rate, having established that there is widespread agreement about what is wrong with our healthcare system, Obama argued that there is also widespread agreement--within Congress, at least--about many steps that need to be taken to correct the situation. And he argued that there has actually been significant progress toward creating reform legislation.
We've seen many in this chamber work tirelessly for the better part of this year to offer thoughtful ideas about how to achieve reform. Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week. That has never happened before. Our overall efforts have been supported by an unprecedented coalition of doctors and nurses; hospitals, seniors' groups, and even drug companies -- many of whom opposed reform in the past. And there is agreement in this chamber on about 80 percent of what needs to be done, putting us closer to the goal of reform than we have ever been.According to the president, these points of agreement are:
- People who already have health insurance through an employer or through Medicare, Medicaid, or the VA, would get to keep what they already have. (Although, as Matt Taibbi points out, if the insurance you get through your employer now is really awful, you would still be stuck with it.)
- People who have insurance could not have their coverage canceled or "watered down." There could be no yearly or lifetime limits on coverage. There would be a limit on out-of-pocket expenses. Insurers would be required to cover routine checkups and tests such as colonoscopies or mammograms.
- Individuals and small businesses that don't currently have access to affordable insurance would have access to something called a health insurance exchange. Because all these people would be pooled together as one group, they would have (at least in theory) the kind of collective bargaining power that government and large businesses now have. Insurance companies would participate in this system because it would give them access to millions of new potential customers.
- Individuals and small businesses that still couldn't afford the insurance offered by these exchanges would receive subsidies based on their ability to pay.
- Large businesses would be required to provide insurance for their employees. Most individuals would be required to purchase health insurance. There would be hardship waivers for individuals who couldn't afford insurance, and 95 percent of small businesses would be exempt.
After showing how much agreement Congress already has about health insurance reform, the president openly confronted the orchestrated right-wing backlash to reform that developed over the summer.
The heckler in this excerpt was reported to be Republican Rep. Joe Wilson of South Carolina.Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim made not just by radio and cable talk show hosts, but by prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Now, such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple. (Applause.)There are also those who claim that our reform efforts would insure illegal immigrants. This, too, is false. The reforms -- the reforms I'm proposing would not apply to those who are here illegally.AUDIENCE MEMBER: You lie! (Boos.)THE PRESIDENT: It's not true. And one more misunderstanding I want to clear up -- under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place. (Applause.)
The president went on to confront claims that his plan represented a "government takeover" of health care. Here is where I had my most ambivalent feelings. I'm as skeptical of government as the next person, but I think there are some services that don't operate well as private industries, and I think health insurance is one of those. The president actually made a similar point in his defense of the limited public option that four of the five committees working on health care have included in their bills:
My guiding principle is, and always has been, that consumers do better when there is choice and competition. That's how the market works. (Applause.) Unfortunately, in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company. And without competition, the price of insurance goes up and quality goes down. And it makes it easier for insurance companies to treat their customers badly -- by cherry-picking the healthiest individuals and trying to drop the sickest, by overcharging small businesses who have no leverage, and by jacking up rates.I don't think the limited public option in the healthcare bills before Congress does much to address the relentless profit-seeking of private insurers. It's only available to people who don't have insurance who are shopping for coverage through the exchange, and the president himself says that maybe five percent of people will be covered by it.Insurance executives don't do this because they're bad people; they do it because it's profitable. As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill, they are rewarded for it. All of this is in service of meeting what this former executive called "Wall Street's relentless profit expectations."
I think it's proper and necessary that some essential services--like health care--need to be made available for the public good, and not for the relentless profit expectations of Wall Street. I agree with Jeff Cohen that if Obama--or at least the liberal groups who are his allies--has started out pushing for a single-payer plan, we might have been able to win a strong public option that would have helped provide quality care at an affordable price. Now we are left with a situation in which Obama gives a ringing endorsement of a limited public plan, but says he's willing to trade it away.
Now, it is -- it's worth noting that a strong majority of Americans still favor a public insurance option of the sort I've proposed tonight. But its impact shouldn't be exaggerated -- by the left or the right or the media. It is only one part of my plan, and shouldn't be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage available for those without it. (Applause.) The public option -- the public option is only a means to that end -- and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have. (Applause.)
Okay. There was more of the president's speech that I haven't addressed. I don't have a grand concluding statement. But I think I've gone on about long enough, and it's almost time for me to go to work. My reaction to the president's speech remains contradictory.
On the one hand, I have serious concerns about what the president has proposed, and don't think the final bill will address those concerns. I think if progressive groups had worked harder and smarter for a more far-reaching proposal, we would have gotten a better result.
On the other hand, there is the reality of powerful right-wing opposition to health care reform to deal with, and we can't ignore that or merely wish it away. The right wing in this country remains extremely powerful, not necessarily because of whatever popular support it might have, but because it is extremely wealthy, well-organized, and well-connected. Obama's plan may be a realistic way to deal with that. I was moved by his sincerity last night, and impressed by his skill. Maybe what we have here is a good starting place. He says he hopes he is the last president to deal with health reform, but I hope he's wrong. What we have is a good first step on a very long journey.
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