(Updating)
I was part of a panel PBS assembled last night to "annotate" President Obama's State of the Union, and here is what I wrote:
The President signalled that he is ready to help Congress finish health care reform, but he did not lay out a specific legislative pathway in the speech. I hope he's doing that behind the scenes.
He did remind us why all Americans should support reform, and why, without new market rules that only the federal government can set, we will not really change insurance markets enough. He linked the hard work of delivery reform to strengthening Medicare and lowering premiums for families and small businesses, and to getting our fiscal house in order in the long run.
He also acknowledged personal responsibility for some of the confusion that many of the American people share about what's really in this bill, responsibility for not explaining the provisions clearly enough.
The question remains, will he make it clear that he will go the extra 10 miles in talking to the American people so that members in both chambers will feel comfortable enough to support the reform bills that are far better than the status quo and are feasible right now? That is one key question for the reform effort and this presidency that will be answered in the coming days.
I would like to add the following thoughts:
The President’s State of the Union address may have given the impression to some that Congress is going to rethink the current health care legislation in the name of bipartisan reform. But I suggest that the nuance of the President’s openness to bipartisanship is critical. While I was glad to hear the President offer to listen to all constructive ideas, I was also thankful he was clear that he is not interested in starting over and pretending that last year did not happen.
So what did happen last year? Finance Committee Chairman Max Baucus and many other Democrats – including Senators Ron Wyden, Blanche Lincoln, Kent Conrad, Jeff Bingaman, and Mary Landrieu – tried as hard as physically possible to elicit bipartisan support for real reform. Yet after months of substantive discussions, Senator Grassley backed away from concepts he had supported all year and in years past. This likely had more to do with fears of a conservative electoral challenger in Iowa and pressure from Republican leadership than the actual policies being discussed in the Finance Committee.
Only Senator Snowe voted for the Finance bill, and even she joined her Republican colleagues in united opposition to the final Senate bill. And let us be clear. The Senate bill contains many ideas that Republicans have supported in less partisan eras, including: the individual mandate, competition among private insurers, quality transparency, and serious cost control that reduces the deficit.
So let us go back to what the President actually said last night:
…If anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.
What this means is that a proposal like the one offered by House Republican Leader Boehner is not worth anyone’s time (including Boehner’s). Scored by the nonpartisan Congressional Budget Office on November 4, 2009, it would cover 3 million people at most. (This is compared to more than 30 million under both the Senate and House legislation.) Instead of making insurance markets more fair, it would increase insurer freedom to discriminate against the sick by allowing insurers to sell across state lines without having a national framework of guaranteed issue, rating rules, and subsidies to improve affordability. Instead of strengthening Medicare for seniors, Boehner’s bill fails to address the profound problems in our delivery system.
This proposal and others like it are not serious health reform proposals. Rather, they are subterfuges designed to provide talking points and nothing more. When Republicans are willing to talk about how to cover all Americans and make our delivery system and existing Medicare program sustainable for the long haul, then, and only then, we will be ready to have a bipartisan conversation about health reform in this country. Until then, the Democrats have to act consistently with the centrist spirit that reigns in both the Senate and House versions of health reform and explain the legislation to the majority centrist American people.
Senator-elect Scott Brown voted for and still defends the Massachusetts reform plan. Current legislation is more centrist than Massachusetts’ approach. (Massachusetts was more generous with subsidies, relied less on private insurance, and paid far less attention to cost growth control than does federal reform.) No elected Republican seems willing to admit this now. Instead, we hear over and over again that “Obamacare” is a “government takeover” of one-sixth of the economy. This is absolutely compelling proof that the vast majority in the Republican party are not ready to have a serious conversation at this point in our nation’s history, I am very, very sad to say. Maybe it is because they think they will get power back this way. Maybe that is why they would rather exaggerate shamelessly than legislate. We have to acknowledge this, and heal the breach another day. Now is the time to move health reform forward.
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