Outside Washington, there is still a sense that a serious debate about healthcare reform is going on.
In Washington, there is a good deal of fear among informed and engaged progressives that the debate may be done.
Yes, of course, something called “reform” might be enacted this year by a Congress where Democrats control both the House and Senate by overwhelming majorities and signed into law by a Democratic president who says reworking the healthcare system is a top priority of his administration.
But the measure of whether this “reform” really does amount to the change promised by Barack Obama’s 2008 presidential campaign now comes down to a simple question: Will whatever legislation that is enacted create a sufficiently robust government-run “public option” to serve as an alternative to the expensive and restrictive offerings of the for-profit insurance industry?
The answer to that question is taking shape today on the powerful Senate Finance Committee, the last of five House and Senate committees that must advance a health care proposal before the real wrangling begins on Capitol Hill.
Committee chairman Max Baucus, the Montana Democrat who has been accused of doubling as an insurance-industry representative, has proposed a $900 billion plan that would require all Americans to obtain health insurance but that lacks the government-run public health insurance option that is the baseline demand of progressives who would prefer a single-payer “Medicare for All” reform.
Two key Democratic members of the finance committee, West Virginia’s Jay Rockefeller and New York’s Chuck Schumer, will attempt today to get it to back some form of a public option.
That would bring the finance committee’s proposal more in line with proposals already backed by three House committees and the Senate Health, Education, Labor and Pensions Committee.
If they succeed, that will make negotiations to reconcile the differing proposals, which have already begun in the House, a good deal easier. And the public option –perhaps even in a form similar to Medicare, with lower premium costs and greater flexibility — would remain a reasonably viable prospect.
If Rockefeller and Schumer fail, the public option will be dealt a serious blow — and with it the prospects for anything akin to real reform.
To succeed, Rockefeller and Schumer must win broad support from the 13 Democrats on the committee. (The 10 Republicans are expected to vote “no” on the three amendments being offered by Rockefeller and Schumer.)
That won’t be easy, as the finance committee’s Democratic membership includes a number of senators who have erred on the side of caution when it comes to reform, including North Dakota’s Kent Conrad, Arkansas’ Blanche Lincoln and, of course, chairman Baucus.
The votes will be close.
The stakes could not be much higher.