Because They Are Hard

The Furor It Will Cause Is Perhaps the Best, Albeit Unpleasant, Reason to Pass Healthcare Reform Now

The odds are still against Democrats managing to get a healthcare reform bill passed and on President Obama’s desk for signature. However, two developments this week have helped its dubious chances and provided proponents with some much needed momentum.

With absolutely no Republican support a given, House Speaker Pelosi must count on recalcitrant Democrats to give her the two hundred and sixteen votes she needs. The troublemakers fall into two categories.


The first are liberals who voted for the House bill back in December but threaten to vote against endorsing the Senate version, citing the lack of a public option and other aspects to which they object as taking the teeth out of real reform. Efforts to convert them got a boost when Representative Dennis Kucinich of Ohio, one of the most left-leaning members of the Democratic Party, announced his intentions on Wednesday to support the bill.

As recently as Sunday, Kucinich was a firm “no.” Writing in the Cleveland Plain-Dealer, he characterized the President’s plan as “a step in the wrong direction,” arguing that “as it currently stands, [the plan] leaves patients financially vulnerable to insurance companies.”

Repeated personal lobbying by Obama convinced Kucinich to change his mind. “I know I have to make a decision – not on the bill as I would like to see it but as it is,” he reluctantly conceded, while expressing hope it represented movement “in the direction of comprehensive reform.”

The second category of Democratic lawmakers targeted by Pelosi is conservative “Blue Dogs.” Many of them voted against the House bill in December, citing budgetary concerns. Others, led by Representative Bart Stupak of Michigan, claim the Senate version will allow federally funded abortions. While not as well known as Kucinich, Representative Dale Kildee, also of Michigan, may prove a trendsetter for conservatives by announcing his support for the bill.

Kildee released a statement Wednesday that he concluded the Senate bill provided sufficient restrictions. “Voting for this bill in no way diminishes my pro-life voting record or undermines my beliefs,” he declared.

Added to this was support by sixty leaders of U.S. Catholic religious orders, representing sixty thousand nuns. Breaking from the U.S. Conference of Catholic Bishops, the nuns proclaimed the Senate bill “will uphold longstanding conscience protections and it will make historic new investments . . . in support of pregnant women. This is the real pro-life stance and we as Catholics are all for it.”

Amid the general tumult, Fred Barnes, editor of the Weekly Standard and a commentator on FOX News, has penned a piece for the Wall Street Journal today arguing against passing the bill. Barnes is clearly opposed to the legislation, maintaining supporters “low-ball its cost and exaggerate the means for paying for it.”

However, the crux of his argument is that rather than settling all the controversy, passage of the bill “would perpetuate [healthcare reform] as the dominant issue for decades to come, reshape politics, create an annual funding crisis in Congress, and generate a spate of angry lawsuits.” Barnes laments the resulting furor will “preoccupy the President, Congress, and millions of average Americans for the foreseeable future – and then some.”

Barnes makes a valid point. At a time when the economy and job creation continue screaming for attention, healthcare reform has dominated Washington’s attention for the past fifteen months in downright obsessive fashion. Nor do I doubt that all of the predictions Barnes makes will become reality should healthcare reform pass.

Rather than resting on their laurels, liberal Democrats will only attempt to expand reform, with a public option their most likely first objective. Republicans, rather than licking their wounds, will continue to do everything in their power to resist, delay, and water down the bill’s mandates. When the day inevitably comes when the GOP regains control of Congress and/or the White House – be that in 2010, 2012, or sometime beyond – they will immediately begin work to try repealing everything the Democrats have passed.

Red states and possibly some purple ones as well can be counted upon to trot out the tired but populist mantra of States Rights in order to insist the federal government cannot force universal healthcare upon them. Lawsuits will proliferate, with the question ultimately going to the Supreme Court. Healthcare reform will be challenged as Unconstitutional, based both on its content – with which I doubt the Justices will agree – and the manner in which it was made into law – where I suspect opponents will find more sympathy among the Justices.

Funding for the legislation, whether its scope is expanded or shriveled, will be a bloodbath. Whether the CBO is accurate that the Senate bill is a deficit reducer or critics are correct that increased access will lead to increased use and higher overall costs, the fact remains that current lawmakers were unquestionably craven in leaving the hardest decisions regarding paying for reform to future lawmakers.

I do not buy conservative charges that President Obama and Democratic leaders seek to usurp the Constitution and impose a socialist state, so I will also reject liberal charges that Republican opposition is based solely on the desire to hand Obama a political defeat which will improve their election chances this November. Instead, I think both sides on the reform debate love this country and want to see better and cheaper healthcare for all Americans. It is clear, however, they have diametrically opposing ideas on the best ways to achieve this goal.

Healthcare reform is an incredibly partisan issue but the divide is much deeper and more complex than merely political affiliation. The real split is over whether it is more expensive to pass reform than do nothing or the other way around.

In spite of all this, in fact precisely because of it, I disagree with Barnes and see continued preoccupation with healthcare reform as the best possible reason to pass the current Senate bill now. The argument he advances – that the fallout will be too great as well as ill timed – is pragmatic on its face but cowardly at its heart. Universal healthcare is a moral and a financial question but concerns over the latter have been used by acolytes of the status quo to resist progress on the former since the New Deal.

I do not know if the defeat of this bill will scare off lawmakers from meaningful reform for another fifteen years, as some have direly predicted. However, I strongly feel that leaving the thirty million Americans this bill would cover uninsured must not continue even another year. I have come to believe that no serious, bipartisan discussion about funding mandated universal healthcare can occur until that mandate has become fact. This is the path, with all its accompanying upheaval, toward which the Democratic bill pushes us, perhaps at times against our will.

As former President Kennedy once observed, society, through the agency of government, takes on large-scale visionary projects like healthcare reform “not because they are easy but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win.”

Another reason cited by Kucinich for changing his vote was that all Democrats need “to be very careful that the potential of Obama's Presidency not be destroyed by this debate.”

Unfortunately, it is probably too late to avoid such damage. Even if he somehow manages to convince Congress to pass the bill, healthcare reform will earn Obama eternal enmity from some voters in exchange for every voter for whom it earns praise. There is no question that Obama seriously misread the public’s desire for universal healthcare coverage following his election. Yet his continued support of the measure is a reminder that true leadership is often not measured by sustained political popularity.

Again, to paraphrase Kennedy, “It is for these reasons that I regard the decision last year to shift our efforts in [healthcare reform] from low to high gear as among the most important decisions that will be made during [Obama’s] incumbency in the Office of the Presidency.