The Health Care Letdown
By WILLIAM F. PEWEN
Washington
nytimes.com
WHILE Democrats may yet enact health care reform via a convoluted process that involves passing three separate bills, many people may wonder, “What happened to the postpartisan era?” Both President Obama’s 11th-hour meeting with Republicans and the Republican leaders’ demands to “start over” are recognized by Americans for what they are — political talk substituting for bipartisan legislation.
As health policy adviser for Senator Olympia Snowe, the Maine Republican, while Congress considered this most critical and complicated issue, I saw firsthand how a failure to recognize the magnitude of the task, and a toxic political environment, undermined the effort to achieve reform.
Republicans rightly note that their role was minimized in four of the five Congressional committees charged with drafting the legislation. Yet many Republicans had decided even before Inauguration Day to block reform, including policies that their party had previously supported. In 2003, for example, Republicans enacted legislation that financed end-of-life counseling — yet in town halls last August they claimed a similar measure would create “death panels.”
Republican cries for fiscal responsibility also ring hollow when you consider the party’s record of establishing higher-cost private Medicare plans and enacting a drug benefit that wasn’t paid for. The fact is that under the Republicans’ watch, critical problems of escalating health costs and access to affordable coverage were largely ignored.
Yet Democratic leadership worsened the erosion of bipartisanship. With dissonant voices excluded, too many Democrats failed to recognize that most Americans, who already have health insurance, wanted the assurance of continued, affordable coverage. Health security, especially in a severe recession, should have been the central concern.
The Senate Finance Committee sought to address that concern by drafting legislation to reform health insurance, provide subsidies to those who cannot afford coverage and achieve better value for America’s health care dollar. Some faulted this committee’s so-called Gang of Six — the chairman, Max Baucus of Montana; two other Democrats; and three Republicans (including Senator Snowe) — for drafting its bill in a prolonged series of closed-door meetings. Yet I witnessed that group make steady progress, and maintain a level of collegiality. The senators were free to discuss options outside the spotlight of the news media. Each party could counter the excesses of the other — a balance that disappeared when Democrats later merged legislation from the two Senate committees into a single bill.
In that merging, the focus shifted to a one-sided political calculus, and away from critical questions like just how much it would cost Americans to carry the minimum amount of insurance coverage required under the emerging bill. Rather than address such concerns, the Democratic leadership, in the interest of political expediency, expanded the scope of the legislation, adding more regulation, spending and taxes. Soon health care reform, which had been achievable, became endangered.
At the same time, Democrats trying to lead health care legislation through Congress made a multitude of missteps. One of these was to fixate for months on the “public option,” only to wholly discard it. Yet Senator Snowe had long offered the option of a “fallback” public plan. This would have allowed insurance market reforms to work, but would have applied the threat of intervention by a public plan to ensure that private health plans actually performed. The Congressional Budget Office confirmed that such a strategy would have pressured private insurance plans to reduce costs.
No less embarrassing was the way the majority leadership killed a bipartisan amendment to establish an F.D.A.-regulated system for importing prescription drugs. Safe importation would have produced nearly $100 billion in savings, $19.4 billion of which would have been realized by the federal government. But the amendment conflicted with the deal Democrats had made with the pharmaceutical industry.
Ultimately, Democrats decided to pass their bill with no Republican support, sacrificing bipartisanship and empowering every Democratic senator to seek inappropriate concessions. I was frustrated because I knew that last-minute deals couldn’t result in a bill that would be correctly drafted, with all its costs clearly delineated, and properly considered by the Senate. The Democratic leadership insisted that a vote must be taken, that debate simply couldn’t continue into January. So midnight votes commenced on legislation that few senators had read and fewer understood. Just pass it, Democrats said, and we’ll fix it later.
Should they succeed in blocking reform, Republicans should take no consolation. When Congress next attempts reform, in a decade or more, health costs and the number of uninsured and underinsured will have escalated — and the likely outcome will be the single-payer system that Republicans most abhor.
Three in four Americans say the health care system needs to be overhauled, and many provisions in the pending legislation have strong support. What’s more, the core of the Senate’s legislation closely resembles the very bill the Republicans offered in 1993 as an alternative to the Clinton plan. This makes clear that bipartisan reform was achievable, and indicts Congress for its failure to realize that goal with broad public support.
William F. Pewen is a former senior health policy adviser for Senator Olympia Snowe, Republican of Maine. |
