Democrats Lost Leverage From Start in Health Care Debate

By
Tuesday, September 15, 2009 at 6:00 am
Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa) (WDCpix)

Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa) (WDCpix)

Democrats pushing for a government-backed insurance option as part of their health reform strategy are finding out the hard way that, by taking single payer health care off the table early, they have little leverage now to force a strong public plan.

Illustration by: Matt Mahurin

Illustration by: Matt Mahurin

Unlike the Republicans, who adopted the strong conservative position of resisting almost every Democratic reform proposal from the start, Democratic leaders ruled out the liberal single-payer proposal early in the debate. Now in search of a centrist compromise, GOP leaders have plenty of room to maneuver, while Democrats are left facing proposals that either dilute the public option or eliminate it outright. Indeed, the Senate Finance Committee is expected on Tuesday to unveil long-awaited reform legislation promoting the creation of private health cooperatives, not a public plan.

For many health reform and patient advocates, the developments have been a disappointment. After gaining both the White House and large majorities in Congress this year, the Democrats have made comprehensive health reform their top domestic priority. On the campaign trail last year, then-Sen. Obama came out in enthusiastic support of a strong public insurance option to compete with private insurers as a way to control premium costs, which are skyrocketing. In Congress, Democratic leaders in both chambers also gave clear endorsements to the public option. Even conservative Democratic Sen. Max Baucus (D-Mont.), who chairs the Senate Finance panel, promoted such of plan in a November 2008 policy paper detailing his “vision for health care reform.”

Republicans have adamantly opposed such a plan. But they’ve also had the advantage of knowing for months that Democrats wouldn’t push for anything more liberal. In August of 2008, for example, Obama said that the best option for health reform might indeed be single payer — which would eliminate private insurers in favor of government-backed, Medicare-style insurance designed to provide universal coverage. But he also conceded that it would be too difficult to launch quickly.

“People don’t have time to wait,” he said.

In May, the White House’s top health official told lawmakers that single payer coverage “is not something that the president supports.”

In the House, Democratic leaders held just one hearing this year on single payer, almost as an afterthought. And Baucus, for his part, ignored single-payer supporters until June, when Sen. Bernie Sanders (I-Vt.), the only upper-chamber lawmaker to support single-payer health care, set up a meeting between advocates and the Finance chairman.

The message to Republicans was clear: Single-payer health care would be off the table from the start.

By choosing the public option — not single payer — as the left-most negotiating point, Democrats left themselves with few places to go but toward more conservative proposals for insurance reform, experts say, including the co-op model and a system of triggering public plans only if private insurers fail to meet certain cost and coverage targets. In the blood sport of congressional negotiating — which dictates that you over-ask, and then move toward your goal during the subsequent bartering — Democrats were asking merely for the public plan they wanted in the final bill. The move, some experts say, provided Republicans with greater leverage to fight the public option. Sen. Kent Conrad (D-N.D.), a lead negotiator for the Finance proposal, has said bluntly that a public plan can’t pass the Senate. Even Obama, in a speech on Capitol Hill last week, walked back his support for the proposal by not insisting that it be included in the final reform bill.

Quentin Young, national coordinator with the Physicians for a National Health Program, a single-payer advocate, said greater congressional support for single-payer coverage early on would have given Democrats greater sway to press their public option proposal now in the face of Republican opposition fueled by August’s town-hall protests.

Not that all Democrats are resigned to defeat. House leaders have promised a floor vote on a single payer bill, introduced by Rep. John Conyers (D-Mich.), which has 86 co-sponsors. Young said the vote, the first of its kind, “in a way legitimizes single payer,” which has never had a vote in the chamber despite decades-worth of proposals endorsing it. Young also theorized that Democrats were forcing the single payer vote in order to “put something up to the left of the administration with hopes of pulling some Republicans to the center.”

Julius Hobson, former lobbyist for the American Medical Association and now a senior policy analyst at the Washington law firm Bryan Cave, pointed to another reason that the single-payer vote is significant: It might rally support from some liberal Democrats who are threatening to oppose the final bill if they deem it to be not progressive enough. The vote, Hobson said, “doesn’t allow any of the various factions to say they didn’t get a shot on the floor.”

The comments arrive as the so-called Gang of Six, a bipartisan group of Senate Finance Committee members, continue their slow negotiations in search of a bill that can win support on both sides of the aisle. Baucus told reporters Monday that he expects to unveil the legislation Tuesday. Last week, Baucus released an 18-page draft summary of the bill, which proposed the creation of regional health cooperatives, but no pubic option. Tuesday’s proposal is expected to offer the same.

Some key Republicans, however, are already voicing doubts that the Baucus bill will attract any GOP support.

There remains the possibility that Democrats could somehow ram a public option provision through the Senate. Indeed, Sen. Tom Harkin (D-Iowa), who was recently named to replace the late Sen. Edward Kennedy (D-Mass.) atop the Senate Health, Education, Labor and Pensions Committee, vowed over the weekend that the Democrats’ final bill would include a public option.

“Mark my word — I’m the chairman — it’s going to have a strong public option,” said Harkin, who as recently as this summer reiterated his long-time support for a single-payer system.

Still, following Kennedy’s death, the Democratic majority in the Senate fell to 59, meaning that party leaders will need to entice at least one Republican to defeat an almost certain GOP filibuster. All eyes are on moderate Sen. Olympia Snowe (Maine) as perhaps the most likely Republican to stray from the party line on health reform. Yet over the weekend, Snowe reiterated her opposition to the public option, telling CBS’ “Face the Nation” that “there’s no way to pass a plan that includes the public option.”

Neither single payer nor the public plan are as unpopular among the public as some on Capitol Hill and K Street like to portray. Indeed, a 2007 poll conducted by The Associated Press and Yahoo found that 65 percent of Americans support adoption of “a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.” A more recent poll, conducted by the Kaiser Family Foundation in July, found that 24 percent of the public “strongly favors” single payer, with another 27 percent “somewhat” favoring the proposal.

Furthermore, a study released Monday by researchers at Mount Sinai School of Medicine found that 63 percent of doctors support the public option, while another 10 percent favor a single payer system that would eliminate private insurers altogether.

Young, who practiced medicine for 61 years before joining Physicians for a National Health Program in 2007, said his group sides squarely with the 10 percent. The public plan wouldn’t accomplish the Democrats’ coverage and cost-containment goals, he said, because it would leave in place the private insurers who “account for virtually all the problems we’re confronting.”

“It’s funny that both the conservative critics and the liberal supporters [of the public option] argue that it’s a stepping stone [to single payer],” he said. “We don’t believe it.”

Comments

29 Comments

The Washington Independent » Democrats Lost Leverage From Start in … « Blogging
Pingback posted September 15, 2009 @ 7:58 am

[...] Here is the original: The Washington Independent » Democrats Lost Leverage From Start in … [...]


The Washington Independent » Democrats Lost Leverage From Start in … | kozmom news
Pingback posted September 15, 2009 @ 8:04 am

[...] the original post: The Washington Independent » Democrats Lost Leverage From Start in … google_ad_client = "pub-3658190228035086"; google_ad_slot = "1112917537"; google_ad_width = [...]


Democrats Lost Leverage From Start in Health Care Debate | Adoption and Orphans Information
Pingback posted September 15, 2009 @ 8:05 am

[...] View post: Democrats Lost Leverage From Start in Health Care Debate [...]


The Washington Independent » Democrats Lost Leverage From Start in …
Pingback posted September 15, 2009 @ 8:23 am

[...] Read more:  The Washington Independent » Democrats Lost Leverage From Start in … [...]


The Washington Independent » Democrats Lost Leverage From Start in … | health
Pingback posted September 15, 2009 @ 8:46 am

[...] View original post here:  The Washington Independent » Democrats Lost Leverage From Start in … [...]


AdsBidWorld » The Washington Independent » Democrats Lost Leverage From Start in …
Pingback posted September 15, 2009 @ 8:51 am

[...] care off the table early, they have little leverage now to force a … Original post:  The Washington Independent » Democrats Lost Leverage From Start in … Categories: Art, Health Tags: and-three, Art, Health, health products, option-as-part, out-the, [...]


The Washington Independent » Democrats Lost Leverage From Start in …
Pingback posted September 15, 2009 @ 9:02 am

[...] Read this article: The Washington Independent » Democrats Lost Leverage From Start in … [...]


The Washington Independent » Democrats Lost Leverage From Start in … | My Health and Lifestyle
Pingback posted September 15, 2009 @ 10:02 am

[...] the original post:  The Washington Independent » Democrats Lost Leverage From Start in … Share and [...]


georgejohnson
Comment posted September 15, 2009 @ 10:42 am

This country is making a big mistake on healthcare reform if there is not a mechanism to drive down costs. Forcing competition thru a public option or single payer would force the insurance companys to become competitive.

It appears that Baucus and the Gang of 6 will not represent the interests of working people for affordable health care, its a sham, and if legislation is passed without the public option or single payer, it will be a boondoggle for keeping costs down and a multi billion dollar subsidy to the drug makers/insurers/ and will result in toothless reform.

Baucus and his democratic counterparts should belong to the republican party, he is a disgrace to the democratic party. They have sold out REAL REFORM


m
Comment posted September 15, 2009 @ 1:05 pm

Did you know that in 9 states, domestic violence is a “pre-existing condition” to deny coverage?

http://www.seiu.org/2009/09/domestic-violence-v…

Can someone tell me why some conservatives want to take away my freedom to choose a public option of some sort? If it's in the name of “protecting” these kinds of private insurers, that is not an answer.


trippin
Comment posted September 15, 2009 @ 1:25 pm

DAMN IT!

AGAIN – CALLING THE PUBLIC OPTION “LIBERAL”

STOP!!

SEVENTY FIVE PERCENT OF AMERICANS AND TWO THIRDS OF PHYSICIANS FAVOR A PUBLIC OPTION.

The problem isn't with Democrats, it's with bullcrap media outlets who continue to paint what three fourths of Americans support as “liberal.”

STOP THIS NONSENSE — IMMEDIATELY.


desmoinesdem
Comment posted September 15, 2009 @ 2:38 pm

A couple of quibbles:

How were Democrats supposed to credibly put single payer on the table when it would have immediately become obvious that we didn't have the votes to get it out of any Congressional committee?

Also, single payer would not eliminate private insurers. In the UK people can buy supplemental private health insurance, just like many Americans in the Medicare system do.


Audrey
Comment posted September 15, 2009 @ 2:52 pm

This is an emotional issue and we all should support covering individuals through private health insurance. To conquer these serious changes, doesn’t it seem right to advocate for greater transparency in both quality and price information, for it overlaps with many other issues? http://www.friendsoftheuschamber.com/issues/ind…


The Washington Independent » Democrats Lost Leverage From Start in … « Top Health Insurance Companies
Pingback posted September 15, 2009 @ 9:25 pm

[...] The Washington Independent » Democrats Lost Leverage From Start in … Share and [...]


rightdemocrat
Comment posted September 15, 2009 @ 11:04 pm

Single payer is really the most fiscally conservative approach to health care. Our medical costs are being inflated tremendously by the insurance industry's huge profits.


splashy
Comment posted September 16, 2009 @ 12:21 am

Ya think? When bargaining, you ALWAYS start from the most extreme position there is, unless you want to lose from the get go. We (the single payer advocates) tried to warn them, but I'm thinking that was the plan from the start. Move everything to the right at the very beginning, so that what would happen is a bonanza for the insurance companies and a cause of suffering and death for the people. That is the capitalistic way, don't ya know. Let the vultures continue to pick at the bodies of the suffering.

We can't actually do anything for the good of the people. The only valid thing to do is for the good of the wealthy. (sarcasm)


James Conner
Comment posted September 16, 2009 @ 3:05 am

The only reason not to put a single-payer system on the table as a bargaining chip is because you want the public plan on the table as a bargaining chip. This suggests to me that Obama and Baucus not only didn't want a single-payer system, they also didn't — and still don't — want a public plan. It's a good thing Baucus and Obama weren't in office 45 years ago or Medicare never would have passed.


PacificGatePost
Comment posted September 16, 2009 @ 4:35 am

The American public is right to be suspicious of leadership that will not take immediate and specific action that would reduce an estimated $200 billion dollars from the Nation’s annual medical bill.

http://pacificgatepost.com/2009/09/health-care-…


Lillis Advocates Starting Strong with Single Payer (alternately titled “What Could Have Been”)
Pingback posted September 16, 2009 @ 8:59 am

[...] The Washington Independent’s Mike Lillis makes a compelling case for single-payer health care, but not like you might expect. It’s an article to which I found myself nodding throughout and thinking “Huh. Never thought of it like that.” Read it here. [...]


Pelosi on Baucus Proposal: ‘The House Bill Clearly Does More’ | GSA Schedule Services
Pingback posted September 16, 2009 @ 2:55 pm

[...] unveiling of the $856 billion proposal is indication that this debate is just getting started. And the public plan — absent in the Finance bill — is going to be at the center of [...]


5 Powerful Ways to Earn More Money From Affiliate Programs - Best Paying Affiliate Programs
Pingback posted September 17, 2009 @ 12:35 am

[...] The Washington Independent » Democrats Lost Leverage From Start in … [...]


Progressive Nation » Blog Archive » Congress Explores Private Insurance “Death Panels”
Pingback posted September 17, 2009 @ 4:33 pm

[...] government-backed health insur­ance plan to com­pete with the pri­vate com­pa­nies. Such a pub­lic option, Pot­ter argued, is “absolutely vital” in order to pro­tect patients from the [...]


DOUGLASFIELD
Comment posted September 17, 2009 @ 10:37 pm

* THE FINE ART OF DENYING 45 MILLION AMERICANS HEALTH~CARE IN OUR JUDEO~CHRISTIAN NATION *

AMERICAN RELIGIOUS LEADERS ALL ACROSS THE USA HAVE ALWAYS BEEN ABLE TO COUNT ON THEIR RELIGIOUS FLOCK TO CONTRIBUTE(TITHE)THEIR HARD EARNED MONIES TO THEIR MINISTRIES EVERY WEEK.

THE MAJORITY OF AMERICANS ATTENDING RELIGIOUS SERVICES IN THE U.S. ARE MIDDLE~CLASS AND WORKING POOR CITIZENS WHO NOW DESPERATELY NEED THE HELP AND SUPPORT FROM THESE SAME U.S.RELIGIOUS LEADERS IN LOBBYING THE U.S.CONGRESS TO PROVIDE PROPER HEALTH~CARE FOR ALL POORER AMERICANS.

***THERE ARE CURRENTLY AN ESTIMASTED 45 MILLION MEN WOMAN AND CHILDREN WITHOUT HEALTH~CARE IN THE WEALTHIEST COUNTRY IN THE WORLD????

SILENT AMERICAN RELIGIOUS LEADERS WHO ALL HAVE HEALTH~CARE FOR THEMSELVES AND THEIR FAMILIES IS MUCH MORE FRIGHTENING THEN THE POSSIBLE DENIAL OF A FUTURE HEALTH~CARE PLAN FOR ALL…

LAWYERS FOR POOR AMERICANS (424-247-2013)
lawyersforpooreramericans@yahoo.com


sirald66
Comment posted September 21, 2009 @ 7:05 am

TinyURL.com/PKB8ZH – is a Single-Payer primer/resource that I maintain which explains SP in a nutshell. Good place to start.


Baby_Bird
Comment posted October 1, 2009 @ 6:58 pm

Civil Liberties Groups should prepare to challenge the constitutionality of federal healthcare reform legislation in the courts.

Before the House completes the debate, drafts and votes on passage of a final version of Healthcare Reform Legislation, you need to know that Article 1 Section 8 of the U. S. Constitution does not grant Congress either the power or authority to enact legislation for overhaul of the nation’s healthcare system as well as a public healthcare option or a Government run single payer healthcare plan.

Specific violations of Article 1 Section 8 of the U. S. Constitution include, but are not limited to:

1. Social engineering of the national health care system or complete overhauling of the healthcare system (including a public healthcare option or Government run single payer healthcare plan, and individual and employer mandates) is “Unconstitutional” pursuant to Article 1 Section 8 Clause 1 “The Welfare Clause”, Article 1 Section 8 Clause 3 “The Commerce Clause”, Article 1 Section 8 Clause18, “The Necessary and Proper Clause paired with the Commerce Clause” and the 9th and 10th Amendments to the U. S. Constitution.

2. The highly controversial individual mandate and penalty (or excise tax) of $750 or $1,900 on individuals who do not have health insurance is likewise “Unconstitutional” pursuant to Article 1 Section 8 Clause 1 “The Welfare Clause”, Article 1 Section 8 Clause 3 “The Commerce Clause”, Article 1 Section 8 Clause18, “The Necessary and Proper Clause paired with the Commerce Clause” and the 9th and 10th Amendments to the U. S. Constitution.

3. Specific constitutional problems with both the House Healthcare Reform Bill (or H.R. 3200) include, but are not limited to:

a. Outside Washington, DC and the federal territories, the Federal Government does not have the constitutional authority to control healthcare.
b. As can be seen in current healthcare proposals, Congress cannot delegate any of its authority to the Executive Branch.
c. The federal intrusion into the doctor-patient relationship violates the “substantive due process” principle. (Note: simply put, “substantive due process” holds that the 5th and 14th Amendments’ “due process clauses” must protect not only procedural rights but also “substantive” rights which are those more fundamental rights of freedom to do certain things the government may not desire the individual to do. It holds that due process cannot be completely just if it is applied to unjustly deprive a person of his basic human liberties.)
d. Citing the 10th Amendment, the Supreme Court holds that Congress may not “commandeer” state decision-making in the service of federal goals.
e. While Congress may condition grants to states, if those conditions are “coercive” then the mandates contained in the House Healthcare Reform Bill (or HR 3200) violate that prohibition against coercion.

It is cautioned that imposing national healthcare has serious “constitutional dimensions”. The seemingly unbridled federal overreaching of Article 1 Section 8 Clause 1, “The General Welfare Clause” of the U. S. Constitution would necessitate the enactment of the Enumerated Powers Act (HR 450) which is currently buried in the Democratic-dominated House Subcommittee on the Constitution, Civil Rights & Civil Liberties.

Probably the overarching constitutional concern is the “individual mandate” which would require every American to have health insurance, if not through an employer then by individual purchase. This requirement would particularly affect young adults, who often choose to save the expense and go without coverage. Without the young to subsidize the old, a comprehensive national health system will not work. But can Congress require every American to buy health insurance? In short, the answer is “No”. The Constitution assigns only limited, enumerated powers to Congress and none of the power to promote the General Welfare regulate interstate commerce or to impose taxes, would support a federal mandate requiring anyone who is otherwise without health insurance to buy it.

Specific constitutional problems with the “individual mandate” are as follows:

1. If a Healthcare Reform Bill is passed, individuals will be forced to either buy health insurance or not buy health insurance or pay a penalty (i.e., excise tax, excise fee, fine, etc). Of course it’s not constitutional. The 10th Amendment explicitly limits the Federal government to only those functions specifically enumerated in the Constitution. I have reread the Constitution and am still unable to find the clause that permits the Federal government to provide healthcare. A reading of THE FEDERALIST PAPERS clearly dispels the notion that the reference in the Constitution’s Preamble to the promoting the general welfare trumps the 10th Amendment. Because of the vagueness of the “general welfare” clause, the Congress is really trying to stretch its political outreach to overhaul the entire national healthcare system and already has gone way beyond what is mandated by Article 1 Section 8 of the U. S. Constitution.

2. Secondly, the House Healthcare Reform Bill (or HR 3200) contains a provision to amend the Internal Revenue Code of 1986 to impose “Taxes on Individuals Not Obtaining Acceptable Coverage”. This clearly violates Article I, Section 9, paragraph 3 of the Constitution that provides that: “No Bill of Attainder or ex post facto Law will be passed.” Singling out individuals or groups for punitive taxes because they don’t behave as the government demands is clearly prohibited. No one can argue that it would simply be a penalty or sentence for breaking the law because it denies due process and a trial by jury. The government would simply pronounce you guilty and confiscate your money.

Any major healthcare overhaul could face legal tests of constitutionality by the Judicial Branch. The House Healthcare Reform Bill (or HR 3200) cites the commerce clause or any other enumerated power to warrant its authority. In fact, the only reference to the Constitution in any proposed healthcare reform legislation is a severability clause which is intended to spare the remainder of the bill’s provisions if a part is declared unconstitutional. Maybe the drafters of these Bills really do understand the constitutional ramifications after all and are trying to cut their possible losses.

In any event, Congress will have to decide whether it is willing to face a myriad of lawsuits in the federal courts as well as the U. S. Supreme Court regarding the Constitutionality of Healthcare Reform Legislation, including provisions for a public healthcare option as well as both an individual mandate and employer mandate.

It is my belief that it would be in the best interests of House Speaker Nancy Pelosi and all House Democrats and Republicans to obtain an opinion regarding the “Constitutionality” of Healthcare Reform Legislation, particularly in the public option, and the “Individual Mandate” and “Employer Mandate” from legal council through the House Judiciary Committee or Judicial Department. This is necessary to limit the risk of legal tests of constitutionality by a variety of civil liberties unions and groups in the courts.


louis vuitton handbags
Comment posted August 4, 2010 @ 7:48 am

still don't — want a public plan. It's a good thing Baucus and Obama weren't in office 45 years ago or Medicare never would have passed.


louis vuitton
Comment posted August 8, 2010 @ 8:16 am

good


RSS feed for comments on this post.

Sorry, the comment form is closed at this time.