15 Nov

Awed and Depressed by a Health Care Bill


Susan Walsh/The Associated Press Senator Joseph Lieberman telling reporters late last month that he will not allow the health care reform bill “to come to a final vote” if it contains a public option.

Gail Collins: David, when I watched the House of Representatives pass the health care bill over the weekend, I felt the same combination of depression and awe I generally get when I watch Congress do something large. So ambitious! So deeply flawed! Why isn’t it better? But how did they ever manage to get it done?

As you may have guessed, I have mixed emotions.

And now it goes to the Senate, which fills me with nothing but deep, abiding despair. At this point, if I thought they could manage to pry out some version of that Max Baucus Finance Committee bill, which you sorta like and I think is mush, I’d be thrilled.

David Brooks: Gail, my current mood about health care reform was captured by a superb column by our colleague, David Leonhardt today. David shows how the Baucus bill did take a few steps in the direction of serious reform, but the House dropped the ball. To me, this is not a question of policy disagreement, it’s a question of resolve. In the face of a complex blizzard of political pressures, how resolved are lawmakers to bend the cost curve?

I barely support the Senate bill, but at least people there do possess that resolve. In the House, there’s no evidence of it. Lawmakers there seem to be doing just enough to control costs to be able to say they made an effort.

House lawmakers are doing just enough to control costs to be able to say they made an effort.

This is important because what matters in health reform is not only the bill that’s passed but the way it is executed. Recently, Christopher Weaver and Kate Steadman of Kaiser Health News did an excellent piece looking back on past efforts to control costs. These were efforts to make Medicare more efficient or to find ways to encourage cost-effective practices. Most of these efforts failed. Pilot programs were launched but they couldn’t produce measurable gains. In cases where they did produce measurable gains, congressional approval was required to put those efficiency gains into widespread practice. Congress rejected them because doctors or hospitals or somebody else lobbied against them.

The current bills are filed with those kinds of pilot projects. But if the resolve isn’t there, nothing good will come out of them.

Gail Collins: Speaking of nothing good coming of it, allow me to address the Senate. Here are the two things about that governing body that drive me crazy. One is the fact that the majority almost never rules.

It drives me crazy that the majority almost never rules.

We used to think of the filibuster as a dramatic, once-in-a-blue-moon vehicle that was used only in extreme circumstances, like Jimmy Stewart in “Mr. Smith Goes to Washington.” (What I like about that movie, in retrospect, is that Stewart was not standing there, holding the floor all by himself for hour after hour until he collapsed from exhaustion, in order to save puppies or fight unemployment. It was because the evil Claude Rains was trying to destroy his career, and Jimmy had to prove that he was as saintly as ever. It was all about him. So very Senate like.) Or, of course, when the Southerners wanted to stop civil rights legislation.

But now, a minority of senators don’t have to bother to actually keep talking, or take turns talking, or even hang around the chambers to bring progress to a screeching halt. They just declare their intention (it’s the thought that counts) and nothing can go forward without 60 votes.

That’s crazy. If we’re going to have this system, the filibuster should be reserved for matters that can’t be undone later, like important judicial nominations. Or wars. Not normal domestic policy, no matter how large.

Then you come to my second complaint, which is the ego-driven form of bipartisanship that currently reigns in Washington. My current favorite example is a guy I think you’re fond of, Joe Lieberman.

Lieberman was, of course, tossed out of the Democratic Party by the voters of Connecticut when he started questioning whether opponents of the war in Iraq, who were mainly Democrats, really loved their country. Then he ran as an independent and won, mainly because he sent a very clear message that he was basically still a Democrat. He chose to caucus with the Democrats and demanded that he be allowed to keep his committee chairmanship.

Now Lieberman the committee chairman says he’ll oppose the health care bill if it has a public option, because that will add too much to the deficit. That makes no sense to me, since the public option is actually a vehicle to control health costs. But there you are. Connecticut is a state full of insurance companies, and maybe it should come as no surprise that he’s caving in to their concerns.

Here’s another thing that drives me crazy: Lieberman.

But now he’s running around on the Sunday talk shows announcing that he’ll support a filibuster — keep the whole plan from coming up for a vote unless the public option goes. And he says he’s doing this as a matter of conscience. He wants the world to admire him for stopping the Senate from having an opportunity to vote on a health care plan the president campaigned for and a majority of the chamber supports.

If Lieberman had just said “look, this is bad for a big industry in my state and I’m going to use whatever tools I can get my hands on to stop it in its tracks” I would still be in despair, but not in my current state of door-pounding, head-banging rage.

But he wants us to admire him! As if he was risking his career to save puppies or fight unemployment! Where is Claude Rains when we need him?

David Brooks: Let me defend Joe Lieberman for a sec. I think there’s more substance to his argument than you do. The Congressional Budget Office — the holy of the holies — recently concluded that premiums for the public option would be higher than premiums for the private option. That’s because though the public options may save money administratively, it wouldn’t crack down on certain expensive procedures precisely because it is subject to political review.

Interest groups have lobbied to keep Medicare expensive for the past several decades. They’ll certainly lobby to keep the public option expensive. So Lieberman may be right. After the political adjustments, it may drive up costs.

The bottom line is that some people have the resolve to cut costs, including the president. Other people don’t have that resolve. We’ll see who wins.

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