As the ranking Republican on the Senate Finance Committee, Senator Chuck Grassley will influence the shape of health care reform. For that reason, he and Senate Finance Committee Chairman Max Baucus of Montana were invited to lunch at the White House on Wednesday with President Barack Obama and Vice President Joe Biden.
Grassley's message to the president and vice president, as well as to every journalist who'll listen, is that health care reform should be done through a bipartisan bill that can receive 70 or 80 votes in the Senate. (See also Grassley's recent guest editorial at Politico.)
Many Democrats want to include a health care bill in the budget reconciliation process, which would prevent a Republican filibuster. Grassley warns that it would be a mistake to reform such a large part of the U.S. economy without broad support from members of Congress in both parties.
After the jump I'll explain why Grassley is wrong, wrong, wrong about health care reform.
Grassley is wrong about the potential for broad bipartisan agreement on health care.
After his lunch at the White House, Grassley spoke by telephone to Iowa reporters (audio available here) and claimed that using budget reconciliation instead of the normal legislative process would mean "the difference between passing a bill by 51 or 52 votes versus 70 to 80 votes."
Give me a break. Only 66 senators voted to renew and expand the State Children's Health Insurance Program earlier this year. Grassley was among the 32 Senate Republicans who voted no on the SCHIP bill. If any health care bill had potential for broad bipartisan agreement, it was that one.
Congressional Republicans who discussed health care with Obama last month had no concessions to offer even after Obama suggested that he was willing to consider limiting malpractice awards. I would put money on Congressional Republicans following their 1993 strategy of not cutting deals with the White House while bashing the president's "government-run" health care plan.
Grassley told reporters on Wednesday, "I would say that I got a great deal of confidence that the White House prefers a bipartisan agreement [on health care]."
I hope that Obama will not set a goal of winning 70 to 80 votes in the Senate for his health care bill. He made lots of concessions to Congressional Republicans while negotiating the economic stimulus bill, hoping to win large majorities in the House and Senate. Instead, the stimulus received no Republican support in the House and only three Republican votes in the Senate (including Arlen Specter, who has since become a Democrat). If Obama learned the right lessons from the stimulus debate, he won't walk into the same trap on health care.
Grassley is wrong about the need for big change to have bipartisan support.
In a conference call with reporters before his White House lunch meeting, Grassley said,
My message for the meeting on health care is that it needs to be bipartisan despite the margins by which Democrats control Congress. The health care system is 16 percent of the economy. That makes it a massive undertaking to impact and change that much of the economy. So all the more reason it ought to be bipartisan.
How convenient. Now that Democrats control the legislative and executive branches, Grassley has decided that bills affecting large parts of the economy should be bipartisan. I don't remember him telling President George W. Bush that he should adjust his hugely important agenda items (like tax cuts or the energy bill) in order to win broad support from Senate Democrats. The Bush White House never compromised more than they needed to get a bill through Congress.
Also, remember that Bush lost the popular vote in 2000 and won in 2004 by a smaller margin than Obama's victory. I never heard Grassley warn Bush against trying to pass bills solely with Republican votes.
Franklin Delano Roosevelt got almost no Republican support for any of the New Deal programs in the 1930s. Congressional Republicans fought Lyndon Johnson when he created the Medicare and Medicaid programs in the 1960s.
Americans understand that the current system is broken. Republican strategist Frank Luntz is advising Congressional Republicans that they must give the appearance of supporting "reform" and cannot afford to deny that there is a health care crisis.
Obama has a mandate for change and should follow through on his campaign promises. The high cost of health care as a percentage of U.S. GDP is precisely why we need the best plan possible, not a watered-down bill that might receive a few more votes in the Senate.
Grassley is wrong to oppose a public health insurance option.
Even if a health care reform bill could be written to win 80 votes in the Senate, that bill wouldn't solve our big problems.
It's important to understand that bipartisan agreement on health care is Senate-speak for no public health insurance option for consumers. Since no Senate Republicans are on record supporting a public option, and at least one Senate Democrat opposes it, Democrats don't have the 60 votes needed to overcome a filibuster of a bill containing this provision.
After his White House lunch, Grassley emphasized his support for bipartisanship rather than his opposition to a public plan, but he bashed the idea of a public option in his guest editorial at Politico:
Third, we must also uphold the promise that if you like the coverage you have, you can keep it. [...]
That's why I'm concerned about a government-run plan that forces people out of private insurance.
In this plan, the government would set the prices, determine which treatments are covered and control costs with a one-size-fits-all package.
As many as 119 million Americans would shift from private coverage to the government plan and put America on the path toward a completely government-run health care system.
Cost shifting already happens in Medicare and Medicaid. Doctors and hospitals are already paid less by public programs. They make up the difference by passing the costs onto their other patients.
If more people entered public plans, even more doctors would stop seeing Medicare, Medicaid and government plan patients.
Employers, especially small businesses, would stop offering coverage since they would be able to tell employees to get their coverage from the government plan.
Eventually, the government plan would overtake the entire market.
Grassley has incorporated lots of tips from the Frank Luntz playbook, but his argument is nonsensical. Offering a public insurance plan that more than 100 million Americans would prefer to the insurance they currently have (or don't have) is not "forcing" people out of private insurance.
In reality, creating competition for private insurers would be good for various reasons I discussed here. A television ad MoveOn.org Civic Action is running in Iowa, Montana and Washington uses humor to make the same points. No amount of public pressure will change Grassley's mind on this issue, but I am glad to see MoveOn.Org Civic Action get out ahead of the corporate propaganda that will soon be flooding the airwaves.
Luntz advised Republicans to present their own "reform" proposal, and Grassley has started working on an alternative bill. Health care blogger Jason Rosenbaum fears Grassley is planning to "doublecross" Baucus.
I assume that Grassley is sincerely trying to talk Democrats into dropping the public option (holding out the impossible dream of 70 to 80 yes votes in the Senate). His own bill is just plan B in case the White House and Baucus don't listen to him. Republicans can then assure Americans that they are not against reform. Perhaps Grassley will spin his alternative as "bipartisan" if he works with Senator Ben Nelson of Nebraska. By the way, Nelson's proposals bear an uncanny resemblance to what the industry group America's Health Insurance Plans wants.
Unfortunately, the experience of Massachusetts has shown that requiring individuals to hold private health insurance without giving them a public alternative won't get the job done.
On a related note, I want to highlight one particularly misleading sound bite from Grassley's conference call with reporters on Wednesday morning:
And few issues touch every household in such a person way as health care. Health care decisions need to stay between patients and doctors. I'm going to be a crusader for not having government interference in a doctor's decision for the patient.
Grassley promises to be a "crusader" against government interference with a doctor's decision, as if insurance company bureaucrats do not second-guess or overrule doctors' orders every day. Only occasionally does this practice make the national news, such as when CIGNA HealthCare denied coverage for teenager Nataline Sarkisyan's liver transplant (with fatal consequences).
Last year Rekha Basu of the Des Moines Register reported on the hell one family went through when an insurance company refused to authorize in-patient treatment for a young man's mental illness.
Grassley must be aware that medical emergencies force many insured Americans into bankruptcy, precisely because even "good insurance" does not always pay for necessary medical care.
In this country, cancer treatments can place "enormous debts" even on people with health insurance coverage.
In this country, even many insured people delay or skip needed treatment for chronic illnesses because of the costs.
In this country, wealthy people can face financial ruin when confronted with a serious accident or illness.
In this country, a life-threatening embolism can leave an insured middle-income family with unpaid medical bills equivalent to several months of the bread-winner's wages.
Grassley's a day late and a dollar short if he's only now getting worried about interference between doctors and patients. Insurance companies have been practicing medicine without a license for many years now.
The advice Daily Kos diarist wmtriallawyer gave Obama in a different context last summer holds true for health care reform as well:
As much as you talk about the partisan rancor that usually stalemates Washington (and I agree with you believe me), you've got to watch out for the so-called bipartisan compromises that actually serve noone but a few entrenched interests.
THIS has been the problem in Washington for years now. The partisan fights occur over issues that actually matter and can benefit the people, and the bipartisan stuff compromises are over insidious stuff that benefits noone but the entrenched few.
The White House and Senate Democrats should not agree to Grassley's terms for the sake of passing a bipartisan health care bill.