By Anthony Wright
Special to Calbuzz
I’m confused. Calbuzz has become indispensible reading on topics, from the governor’s race to California Forward, for its veteran analysis that is informed, policy wise and politically savvy. But all that was lacking is the anti-Obama, anti-health reform rant earlier this week.
The post didn’t describe the policy, bungled the politics, neglected the process and didn’t even pretend to stand on principle.
In the entire screed, readers only get two actual critiques about the actual content of the health reform.
One policy critique is that the bill is “framed and defined” by a “transfer” of money to the “rapacious private insurance industry.” Well, not quite. Of the $800+ billion cost of the bill over 10 years, about half is an expansion of public coverage through Medicaid. The other half is composed of subsidies to low- and moderate-income families, providing a guarantee that coverage won’t cost more than a certain percentage of their income.
That’s not the only sea-change. It’s also a radically different insurance market, where the existing business model — called “underwriting,” “risk selection,” or avoiding anybody who actually needs care — is made illegal.
The other policy criticism is that there is no longer a public health insurance option. We’re angry and disappointed that a handful of senators bucked the will of the majority of the House, Senate and public in blocking it from being in the Senate version of health reform. My organization has been leading organizing efforts all year with that as a top priority. (California should be proud that all California Congressional Democrats — including our two senators and even our seven Blue Dogs in the House — voted for a strong health reform that included a public option. Too bad such efforts was not as successful in a few other states.)
But the public health insurance option, as important as it is, isn’t the only priority. We worked for Medicaid expansions, filling the donut hole in Medicare, affordability subsidies to help families up to four times the poverty level, exchanges with the power to bargain for group rates, standards for basic benefits, the abolition of underwriting and denials for pre-existing conditions, requirements on premiums dollars being used for patient care rather than administration and profit; investments in prevention and other cost containment efforts, and much more. We won all these elements, lost others and we’re still fighting on many fronts.
In the comments, Mark Paul gave a spirited defense of the bill on the specifics. As head of a group dedicated to engaging people to advocate on health issues, I believe it should be possible to be honest — agree with many of his points, and still be clear and active about the significant gaps and problems that need to be fixed in conference committee and beyond.
On the politics, the analysis only makes sense if passing health reform is a routine event that the President flubbed. One could write a completely different take — that President Obama is on the verge of passing a reform more far-reaching than any of his predecessors, despite a century of stalled attempts, from Harry Truman to Bill Clinton. Closer to home, California has also been trying since Governor Earl Warren. The Calbuzz crew might remember just the past decade of attempts which I was actively involved — from John Burton’s pay-or-play measure to Sen. Sheila Kuehl’s single-payer proposal to Governor Schwarzenegger and Speaker Nunez’s compromise less than two years ago.
In other words, President Obama’s hands-off approach to let Congress get dirty in the details — a let’s-do-it-differently-than-the-Clintons strategy — could be seen as more successful. If there’s a critique, the president did place a few firm policy demands on the bill writers — like limiting the cost of the plan to $900 billion over 10 years, and they were geared at passing a bill, and not helpful in getting a better bill. Ultimately, they probably were redundant, given Congressional constraints.
And that’s the biggest failing of the Calbuzz post: Much of the critique of the president should better be directed at Congress, and particularly the rules of the Senate. Beyond the insanity of California having the same level of representation as Wyoming, Utah or Delaware, the 60 supermajority rule creates dysfunction and paralysis. Getting to a supermajority of 60 is a challenge. We in Sacramento know the insanity. As odious as they are, Ben Nelson’s demands for once-in-a-generation health reform are not in the same league as the constitional amendments and other requirements legislative leaders have accepted just to pass an annual budget.
What could have President Obama done on the politics? Sen. Lieberman disliked him enough already to make a big point of crossing party lines to endorse and actively campaign for his rival. It’s hard to see what lever he had with someone working from an ideology of pique.
What can a president do? President Obama spent over $100 million during the campaign on TV advertising on health reform, in order to build a mandate for reform. He put his presidency on the line, but focused on moving the process forward. Two years ago, Gov. Schwarzenegger made his own demands on health reform rather than focusing on what could pass the Legislature. He was the last to figure out he wasn’t going to get Republican legislative support, and ultimately neglected to build the coalition to pass the Democrats in the California Senate.
Finally, the Calbuzz critique isn’t even rooted in principle. The argument is that President Obama should have simply given up at the start. “If they couldn’t see a way to put the votes together, they should have taken on some other signature issue.” Sorry, 30 million uninsured. No luck, millions with pre-existing conditions. Too bad, those who find out too late their coverage actually doesn’t provide coverage when they need it. Not only should we not have passed these reforms that would help you — the President shouldn’t have even tried.
So what’s the endgame? Actually, Californians have a role to play. The negotiations between the House and Senate to reconcile the bill are just underway. Senate Majority Leader Harry Reid will be negotiating largely with Californians, from Speaker Nancy Pelosi on down, including key chairmen like George Miller and Henry Waxman. They’ll be listening to our 53 members, including chairs of key caucuses like Lynn Woolsey, of the Progressive Caucus, Barbara Lee of the Black Caucus and Mike Honda of the Asian Caucus.
Those House leaders need to be pushed to make the final legislation closer to the very good bill they passed in the House. They need the stronger affordability subsidies for low- and moderate-income people, especially important for those in high cost-of-living states like California; the stronger standards to limit of out-of-pocket costs; better benchmarks for employer-sponsored health coverage; more oversight on insurers; no undue exclusions for immigrants or abortion coverage; and to adopt the more progressive financing of the House bill.
This isn’t the end of health reform, but the beginning. Not acknowledging the nuances — both the positives and negatives of a reform — just breeds cynicism and disengagement. That’s not what we need, especially in the next few weeks and in the years ahead, as this debate comes back to Sacramento.
Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition, advocating for the goal of quality, affordable health care for all Californians.