The momentous struggle to bring health care reform to fruition always promised to hinge on several do-or-die moments. The first of those may come tomorrow, when Senate Majority Leader Harry Reid attempts to corral 60 votes to bring the proposed Senate version of a reform bill to the floor for full debate.
The bill represents Sen. Reid’s work to combine the best parts of the various Senate committee bills that came out earlier this year with the bill passed some weeks ago by the House. Saturday’s debate marks the first full-bore legislative challenge because Senate Republicans, save one, already have said they will vote no on the bill in lockstep, and will work furiously to block or kill the vote to open debate.
They will wage this so-called “holy war” — Republican Sen. Orrin Hatch’s term — against opening debate on health care reform, never mind their continuing but deceptive rhetoric about the need for reform and their desire to build a consensus version. That means Democrats must round up the votes of all 58 senators of their party, plus the votes of the two independents — Sen. Bernie Sanders of Vermont and Sen. Joe Lieberman of Connecticut.
That won’t be easy. Three conservative Democrats — Sens. Mary Landrieu of Louisiana, Ben Nelson of Nebraska and Blanche Lincoln of Arkansas — haven’t committed to voting for debate, and Sen. Lieberman is still playing the contrarian. They should be encouraged to vote for debate. To do otherwise could derail any opportunity for meaningful reform.
The Senate bill merits passage to a floor debate. It contains the key elements of constructive reform. And it heralds the possibility of landmark legislation on an issue that has been notoriously and destructively blocked by generations of Republicans. They would callously deny to their unwitting supporters the security of health care that all Republicans in Congress enjoy at taxpayer expense.
The Senate bill would create a government-sponsored insurance plan (akin to Medicare) to compete with private insurers, but it would allow states to opt out. It would ban private insurers from denying coverage on the basis of pre-existing conditions. It would provide subsidies to middle-and-low-income families to help buy insurance, and would bar insurers from using federal funds to cover the cost of abortion. It would not allow illegal immigrants to buy insurance from a national exchange.
It would also generate enough revenue not just to pay its $849-billion, 10-year cost, but also enough to reduce the federal deficit by $127 billion over that 10-year span. Given the soaring cost trend of private insurance and medical care that will continue if the plan is not adopted, that is an tremendous step toward containing run-away health-care costs.
The financing mechanisms reasonably include a requirement for all Americans to purchase a health care policy, a surtax on the nation’s very wealthiest incomes, and a tax on top-end Cadillac insurance plans, those costing more than $23,500 in premiums for family coverage. Reductions of some $450 billion in Medicare’s expected cost increases also would be imposed. Essential parts of those savings would come from eliminated federal subsidies wrongly given by Republicans in 2003 to private, for-profit insurers to woo people out of Medicare through so-called “advantage” insurance. Another significant savings would come from allowing Medicare to bargain directly with drug companies for lower drug prices.
These and other reforms are absolutely essential to providing comprehensive, secure care for ordinary families and wage earners. Republicans will oppose them to protect the insurance and drug industries, even though the American Medical Association has endorsed health care reform. Citizens who unwittingly fall for Republican propaganda against reform will ultimately suffer from unaffordable for health care and cruel claim denials if the opponents succeed in blocking this measure.
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