Congress is approaching the end of its first month in this cycle of grappling with the nation’s failed health care system. There is huge opportunity to win a significant improvement to our system and a major political victory against the far right, but, there is grave danger that the progressive health care movement will be outmaneuvered, reforms will be cosmetic and the far right will be able to make a comeback. A progressive victory depends on our political work right now.
Right wing wants to use health care to break Obama presidency
Last November, we struck a stinging blow against the most reactionary, most cynical, most corrupt section of the far right. A broad, multiracial, people-led coalition drove the election of the first African American president in our nation’s history and won majorities in both chambers of Congress. This victory not only stopped the regressive agenda of the Bush years on its heels, but also opened the door to a myriad of possibilities to advance a worker-friendly agenda, including immigration reform, expansion of collective bargaining rights, sustainable energy policy, environmental protection, greater education funding, and of course, health care reform.
Nonetheless, it is critical to understand that our victory last November has not been consolidated and in next year’s midterm elections, we could lose what we gained.
The electoral ground is slightly in our favor and, according to pollsters, Republican Senate seats are slightly more vulnerable than Democratic seats. The far right knows this and they are resolved to break the back of the Obama presidency. They have chosen health care as the issue to defeat the president and turn the electoral winds in their favor in 2010. Their comeback would make it much more difficult for us to advance a truly worker-friendly legislative agenda.
Their choice to fight the president’s popularity on health care imbues the issue with a dual nature. On one hand, we are fighting to expand access to quality and affordable care for everyone in America; on the other hand, we are fighting to defend the gains of last November. Success or defeat of the president on health care will determine our success or defeat on many other issues.
For progressives, this means that it is very important not to attack Obama, even though he does not espouse all our values. We know that President Obama is not a socialist, but he is a great improvement over the Bush regime. By helping consolidate his victory, it will be easier to push him to support a more progressive agenda.
What’s going on now in Congress
Health care reform is being discussed simultaneously in the House and in the Senate. The Senate has two committees with jurisdiction: Finance and Health, Education, Labor, and Pensions (HELP). The Finance Committee is chaired by Sen. Max Baucus, D-Mont., and the HELP Committee is chaired by Sen. Ted Kennedy, D-Mass.
The Finance Committee has not yet proposed legislation, but it has published a recent outlining its policy visions for the bill. We can expect that the bill that emerges from Finance will be quite conservative.
The HELP Committee has put out a 615-page bill, . There are major unfinished pieces of the HELP bill, but it will likely emerge as more progressive than what we can expect from the Finance Committee.
In the House, three committees have jurisdiction: Ways and Means, chaired by Charles Rangel, N.Y.; Health and Education, chaired by George Miller, Calif.; and Energy and Commerce, chaired by Henry Waxman, Calif. These three committees decided to work together to produce one bill and together are being called the “tri-committee.” They recently published a short that indicates their vision for a bill. The tri-committee report promises a bill that is more similar to what the Senate HELP Committee proposes instead of the more conservative Finance Committee white paper. Essentially, at this point, we still do not have fixed bills. Out of the three bills we are expecting, we have one unfinished bill and two white papers. There is still a long way to go before the final language of these bills is finalized.
Congressional mathematics
As these various bills are written and debated and as we push for the most progressive bill possible, it is important to understand the composition of the House of Representatives.
The House has 435 representatives, 257 Democrats and 178 Republicans. To pass a bill, 218 votes are needed. The 78 most progressive democrats form the Congressional Progressive Caucus. On the other side, the 51 most conservative Democrats form the Blue Dog Caucus. Even though there are 257 Democrats in the House, if we take away the 51 Blue Dogs, only 206 are left. This is insufficient to pass health care reform. Conversely, a conservative proposal would lose the 78 members of the CPC, leaving only 179 votes. This means that for a progressive bill to pass the House, we have to get 12 Blue Dogs or Republicans to vote with us. This is the political battle before us.
We will only get these 12 votes through intense political pressure (preferable) or compromise (less preferable). The onus is on progressives to create the political pressure that win sufficient votes in the House. A very dangerous possibility emerges if the Republicans decide to drop their oppositional stance and join with the Blue Dogs to propose a right-wing alternative measure. The 178 Republicans and 51 Blue Dogs together control 229 votes — enough to pass a bill despite the Progressive Caucus.
On the Senate side, the math is even more challenging because there are fewer progressives and more conservative Democrats.
Another important factor to consider is the fast timeline for reform. Congressional leaders want committees to vote on their respective bills by the end of June and the full chambers to vote on combined bills before their August recess. The House and Senate versions will have to be reconciled in August and September, and if a reform bill passes, the president will likely sign a bill by October. This is a very fast-paced schedule.
Tactics on public option and single-payer
A very emotional issue dividing progressives has been whether to hold off support for a robust public option in order to support the preferred solution, a single, national public health insurance program that covers everyone and eliminates the private insurance industry. Supporters of this single-payer approach have felt excluded from the discussion and are justifiably angry.
The pro argument for holding off for this single-payer approach is that we know this is the best solution. The con argument is that this approach effectively takes us away from the conversation that is happening in Congress because it is not possible currently to gather sufficient votes for a single-payer solution. Exclusively supporting single-payer also puts the Obama presidency and all other progressive issues at risk because we would no longer be actively working for a solution that can lead to an Obama victory to consolidate last November’s gains.
Public option must be allowed to succeed
That said, it’s important that the public option be allowed to succeed. We need to fight for a plan that is national, that is available everywhere from day one, that is government appointed and publicly accountable, and has bargaining clout. Otherwise, the public option will not be able to put pressure on the private companies to “keep them honest”, as our president described. The Congressional Progressive Caucus has outlined a series of to ensure that the public option delivers the best possible service. Conservatives have proposed many modifications to protect their friends in the private insurance industry. Their latest attempt is to replace the public option with many state and regional insurance co-ops. These co-ops would be small and unable to put pressure on the private companies to ensure better quality and lower costs.
The work right now is to push Congress to write the most progressive bill possible with as robust a public option we can get. We have a lot of work to do to force conservative Democrats to support a public option in the House and Senate. Also, it is very important for all progressives, single-payer and non-single-payer alike, to join in and fight for this reform. The only way we can win is for there to be broad unity in our camp. A loss on this reform will not only close the way for a public option, but it will also make it a lot harder for us to push for a single-payer system. A loss will also compromise all our other issue areas.
The organization formed in Obama’s campaign, Obama for America, has stayed active. Rebranded as “Organizing for America” (OFA), its activists are pledging to go door-to-door all over the country to build support for health care reform. OFA is a great venue to start building pressure on conservatives to support reform that will lead to quality, affordable health care for all. Health Care for America Now, a coalition of over 1000 progressive organizations, is also mobilizing for a progressive reform proposal.
Flavio Casoy is a first-year medical resident in the Bay Area.
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