Pass the Health Care Bill and Move On

Time's a-wasting and the economy, education reform and other action that could help the Democrats in November are hanging fire.

The health-care bill before Congress now will have to be approved in the Senate by reconciliation, the process that requires only 51 votes. Of course, Democrats are running scared in the House, also; finding 216 votes there to approve President Obama's health care plan is apparently no sure thing, says majority whip James Clyburn (see the Washington Post story, "Democrats upbeat on health-care bill," here).

The urgency and anxiety Democratic members of Congress feel about voting for the health care bill are provoked by fears that voters will punish them at the polls in November. Republicans, says House minority leader John Boehner are doing "everything we can to make it difficult, if not impossible, to pass the bill." Rep. Paul Ryan (R-Wisc.) has an opinion piece in today's Post that excoriates Democrats for using reconciliation to "achieve political victory" by passing legislation that will drive up insurance premiums, federalize "the regulation of insurance, [narrow] consumer options and [reduce]competition among providers."

Ryan uses Congressional Budget Office estimates to support his claim that insurance premiums will rise. But, he fails to mention that the CBO also estimates that the CBO also estimates that the bill will reduce the budget deficit by an amount somewhere between $920 billion and $1.7 trillion between now and 2030. Given the projected escalation of the deficit over the period, the estimated reduction is a tiny piece of the puzzle, but a critique that uses CBO estimates without acknowledging that the proposed reform does begin to reduce the deficit undermines Ryan's claim to objectivity in the matter. Further, when Ryan, as part of a House majority, had an opportunity in 2003 to control health care costs by allowing Medicare to negotiate drug prices with pharmaceutical companies, he voted with the majority in the House to pass the Medicare Modernization Act, which blocked Medicare from doing so. That action has already added billions to the deficit. Of course Republicans argued at the time that the act was aimed at controlling the expansion of government, but its real consequences were to protect the profits of pharmaceutical companies.

Washington Post columnist Robert Samuelson also says that the health-care bill is a cost-control illusion, but his piece depends on the false hypothesis that the bill is only about covering the uninsured. On his way to pointing out that covering more people is hardly a cost-control effort, Samuelson completely ignores the many features of the bill, like state insurance exchanges, policing of medicare overpayments and initiating movement towards value-based Medicare payments rather than fee for service that are aimed at controlling and reducing health care costs.

In a column in the Wall Street Journal, "Health Reform Passes the Cost Test," Harvard professor David Cutler, an Obama health care advisor, reviews ten potential cost-control measures and scores the health-care bill based on the degree to which the bill relies on each measure. Cutler concludes that the potential savings over the next 20 years from passing this bill now are 10 times greater than CBO estimates.

Rounding up votes for the bill in the House is also made more difficult by resistance from anti-abortion Democrats, but even the Catholic Health Association, a group representing Catholic hospitals that do not provide abortion, has indicated support for the bill. At this point it should be obvious that controlling health care costs is perhaps the most critical long-term variable in reducing the deficit to manageable levels. It should also be clear that no single bill will ever achieve that goal and that passing this bill now is a defensible part of a sustained effort to establish health care justice in this country and avoid ruinous deficits in the future. Democrats frightened by the prospect of facing angry voters in November should recognize three things:

1. Failing to pass this health care bill will not soothe angry voters, either, but it will help to define a Republican attack on timid, ineffectual Democrats.

2. Passing this health care bill now will create a space in which Democrats can force Republicans to vote against financial regulation and confront the failures of the No Child Left Behind Act. Let Republicans defend the indefensible.

Finally, the notion that political life should somehow be made risk-free is the real illusion, the equivalent of staying home and barring the door against all dangers, only to starve to death. The true glory of politics is that it sometimes requires courage.