How is it that a decision next week by a single Senator from Maine will almost certainly determine whether America’s future healthcare system is still in the hands of private for-profit insurance companies and Big Pharma or enables more Americans to get better health care at lower cost? Bear with me, because you need to know what’s likely to happen if she signs on, and if she doesn’t. The next few weeks are crucial.
Scenario One: If Olympia Snowe votes in favor of Max Baucus’s plan — which is favored by the medical-industrial complex because it dramatically increases their customer base without a public option that squeezes their profits — the Baucus plan will be the bill that goes to the Senate floor. Why? Because her vote will give enough political cover to waivering Dems Ben Nelson, Mary Landrieu, Jim Webb, and Evan Bayh to gain their support for the Baucus plan. Which means the White House and the Democratic leadership in the Senate will have a good chance to get the 60 votes they need when the bill goes to the Senate floor in a few weeks.
That Senate vote will push Nancy Pelosi and the House Dems toward the right. That’s because it will embolden conservative and Blue Dog House Dems to threaten to vote against the far stronger bill that’s already emerged from House committees — which, in contrast to the Senate Finance bill, includes a public option, an employer mandate, significant expansion of Medicaid, and larger government subsidies to others with lower incomes. Pelosi knows she can’t get a single Republican vote, so has to count on the support of at least 218 out of 256 Democrats. That means winning over at least 38 conservatives and Blue Dog Dems– many of whom were elected from swing districts and some of whom face strong Republican challengers in 2010. With Baucus’s bill gaining momentum, or perhaps already having been passed, the conservatives and Blue Dogs in the House will demand a bill that’s closer to it. House progressives will put up a fight but there’s little question that the emerging compromise will be to the right of where the House is right now.
The two bills then go to a reconciliation committee where the White House can put some final touches on it before it goes back to the two chambers for a final vote. The White House likes this scenario because it keeps private insurance companies, Big Pharma, and the AMA from bolting. It enables the President to call the resulting bill “bipartisan,” and to claim that it marks real reform. And maintains the possibility of Republican support for financial reform and environmental legislation next year.
Scnenario Two: If Snowe decides not to sign on, history moves in a very different direction. Most importantly, the Senate Dems know they won’t possibly have 60 votes they need. So they’ll have to say goodbye to bipartisanship — perhaps even farewell to Nelson, Landrieu, Webb, and Bayh — and bundle healthcare reform into a “reconciliation” bill that can pass with 51. This new goal post strengthens the hand of Senate progressives on the Finance Committee, like Rockefeller. It also gives more weight to the version of health care reported out by the Senate Health, Education, Labor, and Pension committee — which includes a public insurance option, employer mandate, and more generous subisidies to the poor and lower middle class. Hence, the bill that goes to the Senate floor is much more progressive, and the final Senate’s vote (with 51 votes) better reflects the values of the Democratic base.
This Senate vote, moreover, gives more momentum and legitimacy to the House version of health care — which also includes the public option, employer mandate, broader Medicaid coverage, and more generous subsidies to the lower middle class. That Senate vote thereby reduces the power of House Blue Dogs and conservative Dems to influence the bill that goes to the House floor. It also enables Pelosi to say to them: It’s either this or nothing. If you vote against this bill you’re voting against health care reform. The more progressive Senate bill, plus the stark choice Pelosi poses, garners enough votes from the conservative and Blue Dog Dems to pass a strong bill.
The White House doesn’t like this scenario because the use of a reconciliation bill in the Senate poisons relations with Republicans and risks their support for financial reform and cap-and-trade. It may even make it more difficult for Obama to rely on Republican support for more troops in Afghanistan. But as we move into the gravitational pull of the 2010 midterms, congressional Republicans won’t support Obama anyway, on anything. And remember, George W. Bush used reconciliation early in his first term to enact his huge tax cuts, mostly for the very wealthy. It’s a tried-and-true strategy.
I don’t know about you, but I’m hoping the Senator from Maine votes no next week. If she does, America has a fighting chance of getting real healthcare reform.
Robert B. Reich is Professor of Public Policy at the Goldman School of Public Policy at the University of California at Berkeley. He has served in three national administrations, most recently as secretary of labor under President Bill Clinton. He has written eleven books (including his most recent, Supercapitalism, which is now out in paperback). Mr. Reich is co-founding editor of The American Prospect magazine. His weekly commentaries on public radio’s “Marketplace” are heard by nearly five million people. This entry appeared on his blog.
Copyright 2009 Robert B. Reich