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Health care reform in the balance

interior-health-voteThis article was published in the Sunday Herald on March 21, 2010.

After almost a year and a half of false starts and missed deadlines, the moment of truth has arrived. America’s House Of Representatives will vote yes or no on health care reform today. If Speaker Nancy Pelosi can deliver a majority, Barack Obama will sign the most important piece of social legislation since the 1960s. If she cannot, universal health care is out of the question for another decade, at least.

There is no going back, no more holding on. Obama postponed his trip to Australia and Indonesia in a last ditch effort to convince wavering Democrats. Republicans have used up all the parliamentary stalling tactics at their disposal, honouring house minority leader John Boehner’s pledge to “do everything we can do to make sure that this bill never, ever, ever passes.” On Saturday, Republican members of the Rules Committee offered long-winded amendments, knowing they would fail, purely to waste time.

The endgame began on Thursday, with the publication of the so-called Reconciliation Bill and its accompanying Congressional Budget Office estimate. The House must now pass the Senate’s version of health reform, on the understanding that it will subsequently be amended by a yes or no vote in the upper house. This process is necessary because Republican opposition has been so monolithic that it requires 60 votes to get anything done in the Senate, which is one more than Democrats have, despite the overwhelming mandate they won at the last election.

The tweaked legislation eliminates some of the most egregious sweetheart deals written into the Senate bill, closes a funding gap that requires pensioners to pay for prescription drugs, expands the number of people covered by public health insurance to 16 million and introduces a new tax on families making more than $250,000 a year.

Democrats have been optimistic of succeeding ever since the CBO estimated that the initial ten year cost of the legislation would be $940 billion dollars, with deficit savings of $138 billion in the first decade and more than a trillion in the next. Republicans complained that the non-partisan agency’s figures are approximate, but it has become much harder to deny that reform will save money in the long term.

Now Pelosi just needs to round up the votes. Her three main problems are progressives, who ultimately want an National Health Service-style system and think reform doesn’t go far enough, moderate Democrats worried about losing their seats in November’s midterm elections and opponents of abortion, who have hitched their cause to the bill.

Dennis Kucinich, a staunch liberal from Ohio, was persuaded to switch sides, from no to yes, by a ride with Obama in Air Force One. His ideological colleague Steven Lynch is standing firm, arguing that the bill is “a complete surrender of all the things that people thought were important to health care reform.”

Conservative Democrat Bart Stupak, from Michigan, is against the bill because its anti-abortion language is too lax, even though it excludes abortion coverage from all publicly funded plans and requires women to pay for additional private insurance, in case of an unwanted pregnancy. A group representing thousands of nuns spoke out against Stupak, describing reform as “the real pro-life position” but mainstream Catholic and Evangelical groups are backing him up. A handful of like-minded Democrats could decide the bill’s fate.

Almost all Democrats in Congress want the bill to pass, but a significant minority would prefer not to vote for it, because it is unpopular in their districts. Nationally, there is a fairly even split for and against reform, but local polls in swing districts show that the battle for public opinion has been lost. The backdrop to this, of course, is a determined, duplicitous campaign being waged by defenders of the status quo, backed with limitless insurance industry money. The health sector has spent more than a trillion dollars on lobbyists, television adverts and campaign contributions since Obama took office.

Ohio Congressman John Boccieri announced that he will vote yes even though a clear majority of his constituents are opposed to reform. “A lot of people were telling me this decision could cost me my job,” he said. “I want my mum to know I am standing up today and doing what I believe in.”

Senior Democrats are trying to convince undecided members of their caucus that the legislation will turn out to be popular in the end, once voters see the benefits, just as the Medicare programme for senior citizens did after it was introduced in 1965, following a similar struggle against entrenched commercial interests. The problem is they are all up for re-election this year, long before the most important parts of the bill take effect. Republicans have promised to beat them over the head with the cost of it.

Long-serving California Congressman Henry Waxman summed up the calculation being made by vulnerable Democrats. “They’re facing an interesting moral dilemma, and even if they want to follow their own personal selfish interest to get re-elected, I think they make a mistake to vote against the bill,” he said.

It is likely to be a cliff-hanger right up until the ballots are cast. Pelosi needs 216 ayes to prevail. In the whip counts being tabulated by national newspapers and professional pollsters the margins are so tight that a single vote could decide it, here or there. The number of formally undecided Democrats is dwindling by the hour, but still, no-one can be certain if the legislation will pass. We will find out today.