Much as the health care fight has been a riveting, nail biter, edge-of-the-seat saga of intrigue, twists and turns, it's about to get a lot more interesting. Here's why:
1. It'll be interesting to see what happens to the House bill when it goes before the congressional budget office to get scored. If a bill with a strong public option can cover more people for cheaper, it's going to be hard to convince the public otherwise. If it can cover more people and effectively reduce health care costs, it'd be crazy to do anything less.
2. It'll be even more interesting to see what emerges from conference committee once Baucus and Grassley meet the likes of Waxman and Pelosi. I think the Democrats haven't begun the internal strong-arming that they'll be pulling on the centrist senators in favor of watering this thing down into meaninglessness.
And here's why they should play hardball
1. Democrats have much more political cover than they had for the stimulus vote, where they needed it to be bipartisan to do something as daring as it was. They needed Snowe, Collins and Specter to show we're all in this together. Health is different. For health, they need 50 votes and budget reconciliation. Above all, they need it to work. The public is behind them by wide margins. No one will care if it's bipartisan once it's up and running. They'll own the thing regardless, for better or worse. No matter what they do, Fox News, Talk Radio and the rest of them won't like it. They may as well retain control over the issue.
2. Health care reform will deep-six the Democratic ticket in '10 and '12 if this thing passes and doesn't work well. The compromises they have been pursuing in the Senate look like a guarantee that the new system won't work well. In effect, harmony, bipartisanship and compromise now will likely spell electoral evisceration later.
3. Imagine the disaster if they pass Baucus' bill as written and everyone over 300% poverty is forced to purchase a private insurance plan at upwards of $200/month. Sure, it's going to be under $ 1 trillion over 10 years, but the costs will be shifted down to the little guy both in terms of premiums and in doing little to mitigate the growth that drives them. Better to pay for subsidies via broad taxes and negotiate via federal clout than to mandate that people pay a big bill they can't afford. If you think tax increases are bad politics, that's a recipe for collapse.
4. Regarding the budget: Bush's tax cuts yielded negligible public benefit and cost $1.8 trillion. Medicare prescription drug coverage cost almost $1 trillion and was done through parliamentary guerilla tactics like budget reconciliation. Time for the D's to step up and own this thing and raise the revenues necessary to pay for reforms with teeth.
5. Speaking of reforms with teeth, consider the "public option" for a moment. The government will not put insurance companies out of business. It'll make them sell a few of their Gulfstreams and company villas to be sure, but these guys will figure out how to make a buck under the new rules. They will be able to offer the public attractive, affordable insurance products that rival or surpass the government's. They'll just have to take less off the top for themselves. The only places in the world where private health insurance markets don't function are where where it's illegal. A recurring controversy in Canada is over whether and how the private sector can sell benefits-- something that's nowhere near the discussion here.
And now to argue by metaphor
Like larger rules of life, health insurance companies will be forced to evolve to changing circumstance. But life flourishes wherever it's permitted, be it in mid-ocean trench heat vents or in antarctic lakes. Health insurance companies will be allowed, even encouraged under the new rules. It's just that health insurance companies have been making Garden of Eden profits for too long now. Time for insurance companies to face real competition, and become the highly adapted organisms that we all need to survive.
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