The New Health Dialogue

Sen. Lamar Alexander (R-TN) chastised Democrats today for ‘passing health reform in secret’ and not trying hard enough to reach across the aisle. On CBS’ The Early Show, Senator Alexander said,

For 25 consecutive days the Democrats met. They wrote their health care bill in secret. We didn't have anything to contribute to it. They brought it up in a snowstorm. Voted at 1:00 A.M. And said we have to pass it before Christmas…We were completely cut out of the health care debate.

The Senate debated its health care legislation for 25 consecutive days -- the longest the Senate has stayed in session since 1917. The text of the bill -- and the final amendment from Majority Leader Harry Reid -- were available on the Internet for days before the votes. (See the full-text of the amendment, CBO score, CBO score correction, and summary -- Reid posted the bill December 19, and the vote was on December 24). Could anything have been done differently, more transparently? Even the president has said yes, it could. But the description of a one-sided deeply secretive process is a distortion.

There were months of open public hearings, a bipartisan summit, and Sen. Baucus’ call to action on health reform over a year ago. (The call to action featured principles like an individual mandate, a health insurance exchange, subsidies to help low-income Americans purchase insurance, and no coverage denials based on pre-existing conditions…sound familiar?)

The HELP Committee (which Senator Alexander is a member of) considered health legislation for four weeks, and there were many, many amendments debated. The legislation went through seven full days of debate in the Senate Finance Committee (the longest mark-up in 15 years for Senate Finance). Both committees' proceedings were broadcast live on C-SPAN, and extensively covered in the media.

Negotiations began as bipartisan, in the Senate at least, and particularly among the Finance Committee’s Gang of Six, they were bipartisan for months. They collapsed when and only when it became clear that no bipartisan agreement was possible. Baucus finally concluded that his negotiating partners did not want a deal -- that their political leaders had instructed them not to allow a deal. The political strategy memos urging the GOP to block reform may not have been meant for public consumption, but they too ended up on the Internet.

It is true that the process of merging the two Senate commmittee bills was not public -- but did Republicans really expect to be part of that process, given that they had rejected both of the bills being merged? The merged bill was, again, posted on the Internet. As were all kinds of summaries and comparisons and analyses. Everyone had plenty of time to learn what was in the bill -- including the unpopular provisions which have caused such an uproar. Nobody found out about them weeks later, hidden in the fine print of a bill that had not been made public (as has been the case in the past, and both parties have done it). It may have been ugly, but it wasn't hidden.

What kind of bipartisanship should we expect from here forward? As Len Nichols said on NPR this week, the GOP is not looking for comprehensive reform. They are calling for limits on medical malpractice awards and selling health insurance across state lines -- ideas which didn't make it into law even when the Republicans controlled Congress and the White House. Neither will fix fundamental flaws in the health care system. Neither will protect patients. Neither will expand coverage.

If one side is complaining about being shut out, it's fair to ask, were they shut out or did they opt out?