04 March 2010
How Not to Launch Landmark Legislation
To the Progressive Democrats organized in 2008 for electing a new President, I believe that exhorting your contributing memberships could be more efficient if directed toward Congress and the Executive. The public push, by the Democratic leadership in Washington, has been for bi-partisan cooperation for "The Change" we voted for. This is my response to your continued calls for contributions and letters to Congress demanding a public option, single-payer design and other, longtime aspirations most of us have concluded are required for real reform and universal coverage.
My comments expand on or offer different perspectives than your call for Progressives to organize for influencing the bill that comes out of the Conference Committee. First, I agree with your exhorting the factions to focus on what is, not on what could have been. As you say, unless an unforeseen disaster happens, the Senate's bill will go to the Conference Committee for reconciliation with the House's bill. Despite the histerical polemics of Republicans and some bluedog Democrats, the use of reconciliation as a means for avoiding floor fights in both houses of Congress is not an unknown, devious option. A commentator on NPR reminded us that 'reconciliation' was used to pass the 1965 Medicare Act and the 1984 Contract for America, among others. When asked about the power balance within the Conference Committee between the House and the Senate, David Guerkin responded: "The Senate has more power because of its precarious majority." One day, I wish C-SPAN would broadcast those negotiations live, but I'll not hold my breath.
My comments expand on or offer different perspectives than your call for Progressives to organize for influencing the bill that comes out of the Conference Committee. First, I agree with your exhorting the factions to focus on what is, not on what could have been. As you say, unless an unforeseen disaster happens, the Senate's bill will go to the Conference Committee for reconciliation with the House's bill. Despite the histerical polemics of Republicans and some bluedog Democrats, the use of reconciliation as a means for avoiding floor fights in both houses of Congress is not an unknown, devious option. A commentator on NPR reminded us that 'reconciliation' was used to pass the 1965 Medicare Act and the 1984 Contract for America, among others. When asked about the power balance within the Conference Committee between the House and the Senate, David Guerkin responded: "The Senate has more power because of its precarious majority." One day, I wish C-SPAN would broadcast those negotiations live, but I'll not hold my breath.
Furthermore, I share your frustration with the persons who make up our Democratic Party majority, and their leadership, in both Houses of Congress. I like Nancy Pelosi and her leadership style. She seems well-qualified for being second in line to succeed as President. Harry Reid does not inspire me due to his public style. Perhaps the presence of Joe Biden as President of the Senate, there might have been fewer signs or actions of dissidence or power grabbing by Joe Lieberman during the Senate debates. The Democrats could have controlled the Republicans much better, despite the Republican senators games and perhaps illuminating Republican obstinance, disingenuous use of parliamentary procedures, and unrepentant distortion facts or contrivance of falsehoods during sound bytes or said to appear as facts showed they were wrong. Using the proposed legislation in specific challenges to Republican platitudes could have educated the public about the bill's content while forcing the Republican senators to confine their remarks to relevant disagreement.
As for President Obama, he should have presented a national health system to which we should aspire as a nation. Instead, he chose during the campaign and in office to frame need for changes in America's national health care system by its faults. He chose to elicit change through blaming bad actors in the way we provide health to the nation. I think a better way would be to define for Congress and the nation his new view to what we should aspire for America's national health system. By focusing attention with a strategy of blame, the legislative efforts have been driven by the factions and their lobbyists, being blamed. First among others, are the private insurance industry who sell health care insurance for outrageously costly premiums plus limits of coverage. With a publicly known vision for America's potential in a national health system, a different approach might have been to ask private health care insurers to offer ways they could see themselves contributing to its attainment.
Another blamed group has been Big Pharma, an industry sector owned and directed by manufacturers based in Switzerland, not in the US. Has the US Trade Representative been a front line actor for reducing the costs of Big Pharma's products sold in the US, as brand or generic items? Most of the trade agreements made with countries during the Bush Administration contain agreement to purchase from US drug marketers and to restrict use of drugs that affront Evangelicals in the US.
Two other industry groups have been blamed for raising the high cost of health care: physicians fees and hospitals. Physicians are blamed for high professional fees, for unnecessary diagnostic testing and for practicing defensive medicine for fear of malpractice litigation. Hospitals are blamed for the lack of control over ever-increasing costs of their facilities, personnel and clinical equipment.
Rather than blaming the physicians for their professional fees and the hospitals for unreasonably high charges to patients, they could have been required as an entrée for participation in the focus groups to develop novel approaches given their respective roles and knowledge of new technology becoming available. The White House panels did not need to hear arguments for the status quo; there is sufficient data available to demonstrate that the status quo cannot be sustained. The status quo, the private insurer and cost passthrough approach, fails to provide health care for Americans that is universally available, affordable and of optimal outcomes. The current system does not support the public health policy goals for the United States.
Alas, the Administration and Congress are at the point wherein enacting health care financial reform will be a reconciliation process a year later than it could have been. Not all elements of the Progressive agenda will be in this bill, but major improvements in the system will happen.
What remains as the opposition's primary focus for its public statements is the funding of the estimated $970 billion additional cost in the federal budget. Here, too, I think the Administration could have proposed a different approach to funding reform. None of the new system seem to be funded by reductions in Defense Department budgets. This week Congress will approve a $700 billion Defense Department budget funding without the fiscal scrutiny that social programs receive. If fiscal conservatives are honest in their quest for a minimum goal of government spending via a zero-sum budget (i.e., same total, different uses reflecting changing requirements), then Defense Deparment funding must be included among the trade-offs needed to reach that goal.
Alas, the Administration and Congress are at the point wherein enacting health care financial reform will be a reconciliation process a year later than it could have been. Not all elements of the Progressive agenda will be in this bill, but major improvements in the system will happen.
What remains as the opposition's primary focus for its public statements is the funding of the estimated $970 billion additional cost in the federal budget. Here, too, I think the Administration could have proposed a different approach to funding reform. None of the new system seem to be funded by reductions in Defense Department budgets. This week Congress will approve a $700 billion Defense Department budget funding without the fiscal scrutiny that social programs receive. If fiscal conservatives are honest in their quest for a minimum goal of government spending via a zero-sum budget (i.e., same total, different uses reflecting changing requirements), then Defense Deparment funding must be included among the trade-offs needed to reach that goal.
