While the progress of the Obama health-care legislation resembles what fans of the White House’s favorite sport — basketball — would term winning ugly, based on the House vote it looks like they might pull it off–but at what cost? This legislation will not satisfy everyone, but its significance lies not so much in its imperfections as in what it symbolizes. The naysayers are already pounding the keys — some of them literally — pointing out omissions or griping about its costs.
Yet expecting perfection from a Congress led by the likes of Nancy Pelosi and Harry Reid, who apparently have given up any semblance of collaboration either with themselves, the White House, or even their own members, is asking for the impossible. Pelosi’s maneuverings resembled nothing so much as a drunk trying to walk an imaginary line as she managed to change positions on the legislation, wobbling this way and that and then at the end proclaiming her path was the right one. More pointedly GOP representatives continually referred to the “Pelosi Health Care Bill” with the same derision Democrats used to relish on Newt Gingrich, a clear sign she has become a liability.
Blue Dogs More Bark than Bite?
Even before Barack Obama had delivered his inaugural address, I wrote that the Democratic Congress would have to find some way to unite the fiscally conservative Blue Dogs and the liberal wing of the party. Like many I felt that the most right-wing of the Blue Dogs (think Heath Shuler) might as well be Republicans. Turns out I may have been wrong. The line that the Blue Dogs are Republican pups may be more myth than reality.
Of the 39 Democrats who voted against the health care bill, 24 of them were Blue Dogs. While this provided over 60% of the Democratic “nays,” it represented less than half of the total Blue Dog membership of 52. Missing from the nays were such key Blue Dogs as Baron Hill (the Blue Dog co-chair for policy), Earl Pomeroy (who collected the most of any Blue Dog in contributions from the health care lobby–see below), and Leonard Boswell (who comes from an Iowa swing district).
The big puzzle is not that so many Blue Dogs voted against the health care bill, but that the Blue Dogs failed to hold ranks on the most important issue facing this Congress. The Dogs are renowned for their discipline–in fact their considerable power as a minority in the House stems from the fact that in the past they have voted together. But this time, they folded. Could it be that several stories highlighting the Blue Dogs’ ties to the health care industry may have had an impact?
It was widely reported this past summer that the Blue Dogs raised more money than any other congressional leadership PAC and that more than half of that came from the health care industry. In July the Center for Public Integrity issued an investigative report on the Blue Dogs. Key findings:
- The Blue Dog PAC raises money mostly from other PACs and automatically disburses the maximum possible contribution to each of its members for their re-election campaigns. This helps preserve their ranks, especially since many of them represent swing districts and are among the most targeted incumbents at election time.
- In the 2008 cycle, their PAC received $508,800 from the health care sector (up 90 percent from 2005-2006 cycle).
- In just the first half of 2009, the PAC all told took in $1,058,750 in contributions from political action committees. Health care PACs have already kicked in $297,500 to the Blue Dog PAC.
- Blue Dog founder, former Louisiana Representative Billy Tauzin, is the president and CEO of the Pharmaceutical Research and Manufactures of America.
Meanwhile the Center for Responsive Politics issued its own findings on the Blue Dogs’ cozy ties to the health care industry noting:
The typical Blue Dog has received $63,000 more in campaign contributions from the health-care sector than other House Democrats over the past two decades.
As these facts came to light, supporters of health care reform began putting pressure on the Blue Dogs. Consumer Watchdog’s John M. Simpson charged:
These Blue Dog Democrats seem to know only one trick, that’s to roll over — to roll over for the insurance industry. They aren’t Blue Dogs, they’re insurance company lapdogs.
Richard Kirsch, national campaign manager for Health Care for America Now, a liberal pro-reform group, added his voice:
The Blue Dogs are carrying water for the industry instead of their constituents.
Perhaps the outrage over Blue Dog ties to health care lobbyists did help to break up their unity, but a recent study by Kansas University Professor Burdett Loomis, suggests that the Blue Dogs had been losing their fabled unity long before the health care vote, perhaps due to the pressures of the economic crisis. The Blue Dogs split 25-22 in favor of the first bank bailout and 31 -16 in favor of the second. Forty-three Blue Dogs voted for President Obama’s stimulus package (although it took some maneuvering to get those votes).
Loomis concludes:
As a voting bloc, despite the fears of some liberals and the attention of many journalists, there is little evidence that the Blue Dogs have made much of a difference.
If anything, the health care vote seemed to draw a broader line through the Blue Dogs, separating the moderates from the right-wingers.
Holding the Caucus Together
Two years ago I believed people like the Blue Dogs would make a Democratic victory in the presidential race a tarnished prize, presenting the victor with the equivalent of the divided Congress that continually thwarted John Kennedy and sent him to Dallas in an attempt to heal what had progressed from a festering sore to an open wound.
At the time I openly wondered that some Blue Dogs would cross the aisle, all but destroying the Democrats goal of a Congress immune to filibuster. The fact Pelosi and Reid had the task of serving as trail bosses for this exercise in herding cats did not inspire much confidence.
Yet somehow this herd of cats is on the verge of accomplishing what a half-century of Congresses had been unable to accomplish — reforming the health care system. A hint of how close we are to this historic moment came from Republicans whose objections now are that the bill contains physical gimmicks along with the old war cry of socialized medicine.
As any Washington insider knows that is the equivalent of running up a white flag, since when has there been a bill that has not contain fiscal gimmicks. With considerable aid from groups like the AARP and the AFL, ridiculous charges about death squads and the end of Medicare have faded from the scene. But an old and ugly specter that has hung over American politics for a generation has resurfaced, leaving the fate of the bill in doubt.
Was the Price Too High?
For pro-choice advocates, many wonder if the price to pass the health care bill came too high. The so-called Stupak Amendment, named for Michigan Democrat Bart Stupak, broke what had been an uneasy Congressional truce over the abortion issue, injecting it squarely into the middle of the health care debate.
As I watched the floor debate over the Stupak Amendment, perhaps the most telling moment came in the remarks of Rep. Louise Slaughter (D-N.Y.).
What surprised me was the size of the vote in favor of the amendment and the number of Democrats who supported it. The question is whether for some this represented a “throw-away” vote–one they could take back home but which in the long run is meaningless.
That may be wishful thinking. Even were the conference committee to kill the Stupak amendment, when the final bill comes back to the floor, the abortion foes will bring it back. Stupak himself would look like a hypocrite if he did not fight for his amendment on that final vote.
This means that the final health care bill could very well contain some hard-to-swallow anti-abortion language. Will the Democrats fragile coalition fall apart over this?
The Plot Thickens
Sixty-four Democrats voted for the Stupak amendment, meaning that a significant number of them would have to change their minds to allow the bill to pass without it. Yet there is a serious question of whether a health care bill that will essentially mandate women to purchase separate insurance for abortions is a health care bill at all.
The final tally on the Stupak amendment is here. Should you see any representatives from your area, now is the time to let them know how you feel, for in the end it may not be the insurance industry that kills health care reform, but a group of Catholic bishops.
The bishops entered the health care debate late. Their first letter to Congress came in October. Their second the day before the crucial vote. The bishops have been cited by both sides as responsible for the Stupak amendment, yet these letters do not contain a call for the more sweeping language used in Stupak. In both letters the bishops stated:
We urge members of the House to support an amendment to keep in place current federal law on abortion funding and conscience protections and to oppose a closed rule that would prevent the House from voting on this crucial matter.
In explication of this language, the bishops specifically mention that the bill should incorporate the Hyde Amendment which has been part of federal health care legislation for many years. Yet as Slaughter and others point out Stupak goes beyond Hyde, which it appears both Slaughter and the bishops would have accepted. It is notable that the bishops did not publicly support Stupak until the day of the vote.
In its most recent form, the Hyde/Weldon Conscience Protection Amendment, which was enacted into law as part of the Fiscal Year 2005 Omnibus Appropriations Bill (Public Law 108-447), the Hyde Amendment contains the following two clauses:
(b) Nothing in the preceding section shall be construed as prohibiting the expenditure by a State, locality, entity, or private person of State, local, or private funds (other than a State’s or locality’s contribution of Medicaid matching funds).
(c) Nothing in the preceding section shall be construed as restricting the ability of any managed care provider from offering abortion coverage or the ability of a state or locality to contract separately with such a provider for such coverage with State funds (other than a State’s or locality’s contribution of Medicaid matching funds). [My emphasis]
Stupak eliminates “c,” which is why it has stirred up so much trouble. If I were Barack Obama at this point, I would meet with the bishops, Stupak and those Democrats who voted for Stupak and see if they are willing to accept Hyde as written, as they stated in their original letters. Clearly, the demagogues are driving the train and what now needs to happen is for cooler heads to prevail.
My guess is that the bishops were forced into supporting Stupak at the eleventh hour because they saw no alternative language. Someone needs to offer a compromise that goes back to and incorporates the original Hyde Amendment, including Clause C.
What Is At Stake
The situation is critical, for like a high stakes poker game in which everyone keeps upping their bets, much is on the line. To begin there is the future of health care itself. After the failure of the Clinton Administration to enact health care legislation, it has taken over a decade before Congress and the Obama Administration had the courage to tackle the issue again. Should this attempt fail, meaningful changes in the system that has caused this country to be ranked behind virtually every other advanced democracy in health care may be delayed for another generation.
The social and economic consequences could prove disastrous. From a systems perspective the failure of health care reform in this global economy could cause companies to look elsewhere to locate their corporate headquarters. Meanwhile, the social consequences of poor quality care, the growing numbers of uninsured and an increase in the burdens placed on emergency rooms in public hospitals already stretched to the breaking point could reverberate throughout America, causing costs to rise, in turn pushing a fragile economy into a full-blown depression.
What opponents of health care reform fail to acknowledge is that one way or another we must deal with those who presently cannot afford insurance or quality care. If people do not receive preventative medicine, then they acquire serious illnesses or their so-called pre-existing conditions become worse. Ultimately they end up in the emergency rooms and the intensive care units of public hospitals that must treat such patients at a cost far higher than if these patients had received adequate insurance. Guess who pays the cost for this indefensible situation, the American taxpayer.
The nation would also pay a social cost. People without adequate health care do not become productive citizens. Children with inadequate prenatal care are at high risk for diseases and conditions that will leave them at a disadvantage for the rest of their lives. Adults with acute and chronic illnesses that could have been treated or even prevented may end up on disability and public assistance because they are unable to work.
And how long would those oppressed by a system that denies them health care available to the rich and members of Congress, continue to accept this second-class status? Unrest would increase as groups impacted by poor health care become increasingly angry about the lack of action.
Finally there is an additional scenario no one wants to talk about even in this season of the Swine Flu scare. That scenario is the risk of a pandemic that could rise from the uninsured or under-insured. An inadequate health care system virtually guarantees that at some point someone somewhere will succumb to a malicious virus the likes of which we have not seen for a century. Like Typhoid Mary that person will spread the virus throughout the community long before they seek treatment.
A New England Journal of Medicine study on the Swine Flu virus helps us to understand why this scenario may not be so far-fetched. It notes that of the cases it studied, 73% had an underlying, preexisting condition (BTW, they would not be covered by the Republican health care bill) and a majority of the patients were people of color (according to the Census Bureau people of color account for more than half those without health care coverage): Hispanic (30%), African American (19%), Native American (9%) or Asian or Pacific Islander (6 %). Only 27% were non-Hispanic white. Especially chilling was the finding:
Patients who were admitted to an ICU and those who died were older, were less likely to have been vaccinated for influenza during the 2008–2009 season, and had a longer time between the onset of illness and the initiation of antiviral therapy, as compared with patients who were not admitted to an ICU.
Then there are the political consequences. The Obama Presidency and the Democratic Congress would be permanently crippled. Failure to pass a health care bill would probably result in a major re-alignment during the mid-term elections. Barack Obama himself would be a one term president, probably challenged within his own party as was Jimmy Carter.
One thing is clear — this is about more than health care. The bill itself has become so complex and full of compromises, that it is safe to say most Americans no longer understand it, and if they do not understand it, it is difficult for them to care deeply about it. That is a major mistake on the part of the Democrats and the Obama Administration. Now that they have a bill it is incumbent on them to explain why it needs to end up a desk in the White House.
Certainly, the entire country is weary of the bickering. The lack of partisan cooperation on this key measure will only intensify the Era of Bad Feelings. You could see it in the House debate that at times threatened to get out of hand. There was genuine hatred in the eyes of some Republicans, a hatred that brings us to mind Shakespeare’s immortal “lean and hungry look.” When Iowa Representative Bruce Braley began an eloquent speech that stated the obvious — this is about patients — Republicans shouted him down so that only concerted efforts allowed him to continue speaking.
For millions of American women the demagoging of the abortion issue could become the Plessy v. Ferguson of our generation, creating a separate but unequal system of health care. If you remember your history, Plessy came about because both parties acquiesced to rolling back Reconstruction, sacrificing African Americans for political gain. Will we now do the same with women? If Stupak passes, the rich will still be able to procure abortions, but for middle-class Americans, the poor, people of color it could bring back the reign of terror euphemistically known as the back alley abortion.
In short nothing less than democracy itself is at stake, for already people are asking whether it is possible to govern this country. When democracy itself is called into question history shows radical voices rushed in to fill the political vacuum. We stand to not merely lose health care, but an America founded on the principles of justice and equality.
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