The New York Times says that Obama plans to take a more active role in the upcoming healthcare debate because he’s worried that if he leaves the legislation solely to Congress, it will become too watered down. Supposedly, in a conversation with Senate Republicans, he stated that he’d rather compromise and get 85% of what he wants with some Republican votes than get 100% of what he wants with only Democratic support.
This is troubling and yet understandable, and underlines the great test that Obama will face in this debate.
Congressional Democrats have already agreed to use the reconciliation process for the healthcare vote, which means that it will only require a simple majority and cannot be filibustered. This almost guarantees that Obama could get everything he wants; even if he loses a few “moderate” Democrats, there’s little chance he would get fewer than the necessary 51. He could even go as low as 50 and count on Vice-President Biden for the tie-breaker.
But Obama is making a calculated judgment that in order for healthcare reform to truly be sustainable, both economically and politically, he needs Republican support; otherwise, any reform might be reversed by a future Congress or presidential administration.
The question is what Obama will have to give up to attract Republican support, and whether it will be worth the trade-off. The main element that Republicans oppose is the “public option,” which would allow a government-run plan similar to Medicare to compete with private plans. Republicans fear that this would open the door to single-payer insurance, and that the government plan would have an unfair advantage over private-sector plans.
While in theory there is some merit to this argument, in reality it is largely fallacious. Many nations have both private and public health insurance, and the systems can be structured to compete fairly. Without a public option, which typically has low overhead costs, private insurance companies have little incentive to cut costs—and cost-cutting is ultimately the key to successful healthcare reform. By resisting a public option, Republican lawmakers seem more intent on protecting the profits of big insurance companies than on improving healthcare access and affordability for all Americans.
If Obama were to compromise on the public option, it would represent a tremendous failure of leadership; he would be capitulating to the GOP, and severely damaging the prospects for real reform. As Obama has already stated, if genuine healthcare reform can’t be passed now it will likely never pass.
I would like to assume that Obama’s reputed statement to Republicans (that he’d rather get most of what he wants with some Republican support than all of what he wants with Democrats alone) is simply, at this point, good politics; I would like to assume that he plans to stand firmly behind a public option, even if this leads in the end to little or no Republican support.
If substantive healthcare reform passes and proves successful, its popularity would likely generate the political will necessary to sustain it; at the same time, it would represent an additional political advantage for the Democrats.
To my mind, that’s a risk worth taking.
Jason Scorse