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A bipartisan show of hands

interior-healthsummitThis article was published in the Sunday Herald on February 28, 2009.

As political theatre goes, it was hardly the most thrilling spectacle. The health care summit at Blair House in Washington D.C. was characterised by interminable speeches, testy exchanges and an absence of genuine openness. But although it broke no new ground in a debate that has dragged on for more than a year, it may be remembered as a decisive turning point on the road towards universal healthcare.

For seven hours, Democrats and Republicans maintained the pretence of bipartisanship, knowing full well that agreement is impossible. President Obama was determined to show that he is taking the opposition’s ideas seriously. His opponents were keen to demonstrate that they could be reasonable, rather than obstructive. No amount of platitudes could disguise how entrenched their positions have become.

Republicans repeatedly demanded that Congress should, in the words of Orange Juice, “rip it up and start again.” House minority leader John Boehner had a copy of the 2,700 page Senate health care bill on the table, the better to declare it unconstitutional, unaffordable and impractical. Going back to the drawing board is not an option for Democrats, who have already been wounded by the legislation’s tortured progress through congressional committees. They must pass the bill as it stands or admit defeat.

Boehner thanked the President. “I think it’s been a useful conversation,” he offered. While the session was in progress, his staff issued a memo condemning “job-killing tax hikes, deep cuts to Medicare… an ‘abortion premium’ levied on American taxpayers, vast new powers for the federal bureaucracy and other unacceptable provisions the American people reject.”

Democrats came armed with stories illustrating how the present system fails ordinary families, whether they have health insurance or not. The sad fact is these human tragedies have long since lost their power to shock. When congresswoman Louise Slaughter mentioned a constituent who had to wear her dead sister’s false teeth, conservative talk radio hosts covering the meeting laughed out loud.

House speaker Nancy Pelosi quoted from Ted Kennedy’s deathbed letter to Obama, describing the passage of health care reform as a test of national character. Republicans cited polls that show most people are opposed to the bill. The latest Gallup survey found that only 42% of registered voters support it, even though the majority of Americans think the system is fundamentally broken.

In the live television coverage, this sparring continued through the commercial breaks, which contained the same partisan messages, paid for by insurance and drug company lobbyists, unions and progressive pressure groups.

Evidence of blatant profiteering is the administration’s strongest card. Wellpoint’s Californian subsidiary, Anthem Blue Cross, became instantly notorious when it tried to raise premiums for some of its customers by 39%. The Health And Human Services Department issued a list of similarly steep price rises in Michigan, Oregon and Washington. A coalition called Health Care For America Now pointed out that profits at the nation’s five biggest insurers rose 56% last year, as they provided coverage to 2.7 million fewer people.

Republicans had been asked to bring alternative ideas, so they spent a long time talking about reform of medical malpractice laws, selling insurance across state lines to promote competition and health care savings accounts. But on the core issues of dramatically expanding coverage and preventing insurers from excluding people with pre-existing medical conditions, they had little to offer. “We’ve come to the conclusion,” Senator Lamar Alexander said, “that we don’t do ‘comprehensive’ well. Our country is too big, too complicated, too decentralised.”

Senate Minority Leader Mitch McConnell described American medicine as “the finest in the world,” observing that a Canadian political leader, Danny Williams, recently flew to Miami for heart surgery. According to the World Health Organisation, the USA spends more per person on health care than any other country, yet lags far behind other developed nations in terms of life expectancy and infant mortality.

Despite its stated bipartisan purpose, the summit was clearly devised to show that compromise cannot be reached. This being so, the most important exchanges were about process: specifically the parliamentary tactic known as “reconciliation” that allows for certain aspects of a bill to become law by simple majority vote.

If the House Of Representatives can pass the existing Senate legislation, adjustments can be made this way, although the White House must first convince wavering Democrats that giving up now will be more politically costly than supporting a flawed, unpopular bill.

Republicans objected, reasonably enough, that Democrats have opposed reconciliation in the past. They brought up Obama’s complaint that “majoritarian, absolute power on either side” is “not what the founders intended.” They claimed that the process is unsuited to such divisive, hugely expensive legislation, forgetting that the Bush tax cuts, all $1.8 trillion of them, were pushed through the same way by a Republican congress. Hypocrisy, at least, is bipartisan.

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