By Logan Scisco
Since the summer, the Obama administration has attempted to push healthcare reform through Congress. With 46 million Americans uninsured, the administration and its Democratic colleagues have emphasized the urgency of passing healthcare reform that would provide insurance to these individuals who do not possess insurance because of choice, their economic condition, or because a pre-existing medical condition excludes them from obtaining quality health insurance. The current economic situation in the country, where the official unemployment rate is the highest in 26 years at 10.2% (some have the actual number of unemployed at 17%), would seem to help the administration pass this reform. Another added advantage of the administration going into the healthcare debate is that the Democrats control both houses of Congress and have a crucial filibuster-proof majority in the Senate.
However, Obama’s initial push to pass healthcare reform by the end of the summer bit the dust and when representatives went back to their constituents they faced hostile town meetings. While the media debated the merits of these meetings, they showed how divisive healthcare reform can be as violence was reported at some of the town halls and one man even had a finger bit off. Furthermore, although the House of Representatives succeeded shortly after the 2009 elections in passing a healthcare bill, the Senate is facing a series of complications in ensuring healthcare reform can clear its chamber.
This topic brief will provide an updated focus on the healthcare debate. It will examine the future of the public option, the new controversy involving abortion in the healthcare legislation, and the chances of the Democrats getting a healthcare bill through the Senate.
As a side note, I cannot recommend enough that extempers read as much as possible about the healthcare debate, looking at medical journals such as the American Journal of Medicine and other publications to get a sense of the problems that effect American healthcare. It would also be wise for extempers to read about other “national” healthcare systems that exist in Canada, Great Britain, and France because comparisons in speeches are never a bad idea.
The Public Option
The biggest hurdle for a major healthcare overhaul is the Democratic Party’s liberal base insistence on a “public option.” This public option would result in the government establish a health insurance counterpart to rival private insurance. The idea behind that is that it would establish competitive between insurance companies and bring down the costs of purchasing health insurance. Opponents counter that it is a way for Obama and the Democrats to get America to go down the road to a “single payer” healthcare system where the government would have complete control over healthcare. The argument behind that is that unlike a private business, the government could afford to not turn a profit and because it had no profit motive it could undercut private insurance companies, gradually forcing them out of business. Another complaint is that the House bill imposes fines on small businesses with more than eight employees who do not provide insurance, giving those businesses an incentive to dump their employees into the public option. Also, because current private healthcare costs are high, employers would already have an incentive to dump their employees into a public option to avoid those costs. Opponents point to comments made by Obama and Barney Franks who have said that a public option is a way to work towards a single payer healthcare system.
Although the House bill provides for a public option that would take effect in 2013, the existence of the public option could doom the bill in the Senate. Senator Max Baucus of Montana pushed through a healthcare bill from the Senate Finance Committee that did not include a public option and as a result was able to get Republican Senator Olympia Snowe from Maine to cross the aisle and support the reform. However, Senate Majority Leader Harry Reid has vowed to make sure that the Senate healthcare bill involves a public option. The problem here is that Reid needs to ensure that all sixty Democratic senators are on board with his plan in order to prevent a Republican filibuster. Although Snowe joined the Senate Finance Committee in passing its healthcare overhaul, she has repeatedly argued that she is against a public option. The only version of the public option that Snowe will support has a “trigger” mechanism that would enact a public option if states were not meeting specified targets after a certain period of time. No other Republican has shown that they are willing to break ranks and join a Senate bill that has a public option in it. Recent reports have indicated that three Democrats, Senator Ben Nelson of Nebraska, Senator Mary Landrieu of Louisiana, and Senator Blanche Lincoln of Arkansas are very wary of having a public option in the healthcare bill. Without all three of these senators on board, it is tough to see a healthcare bill getting onto the Senate floor because it would be filibustered and the Democrats would not have the 60 votes needed to invoke cloture (which shuts off debate). Reid has said that the Senate version will allow states to opt out of the public option if they desire, but Republicans see this as a sneaky attempt to impose a public option on the states because the legislation would stipulate that states would have to pass legislation that indicated their desire to opt out. As the New York Times on October 26th noted, the problem with this is that state legislatures and governors would have to agree on the opt out and if there was deadlock on the issue the public option would continue in the states.
The public option is a divisive issue among Democrats in the debate. If Democrats cannot pass healthcare reform with their current majority, which political experts expect to be reduced in the 2010 elections, the opportunity of imposing the Democrats vision of healthcare reform could be lost for years. The liberal wing of the Democratic Party may not forgive the Obama administration for giving up on the public option even if that is what is needed for a healthcare bill to pass the Senate. Reid could use what is called “reconciliation” to try to get healthcare passed with 51 votes, where a filibuster would not be allowed, but this represents the “nuclear option” of passing major legislation. Although Republicans used this to pass the Bush tax cuts, the process of reconciliation is only to be used for budget issues and federal expenditures. Inserting a public option would meet a challenge among Republicans who would allege that it has nothing to do with expenditures and the Senate parliamentarian, a man named Alan Frumin, who is supposed to be impartial and is not elected, would have to make a ruling about whether the Republican objection was valid. In simple terms, the fate of a public option in healthcare reform may end up depending on one man.
As an aside, support for the public option does exist. A recent CBS poll shows that 51% of Americans want a public option in the healthcare bill while 26% want no bill and only 16% favor a healthcare bill that does not have a public option. From a different perspective, the Rasmussen polling agency (known to lean a bit to the right but is known for nailing the 2008 presidential election result) shows that 47% of Americans favor the current healthcare bill with a 49% opposed. However, it is worth mentioning that when asked what the public option is or when told what elements might be in a public option, the public cannot explain the public option or support for it tends to decline.
Check back tomorrow morning for the second half of this brief.