By Bill Boyarsky
Just pass the damn thing. If the health care bill fails, President Barack Obama’s legacy could be limited to the failing war in Afghanistan. Worse yet, many thousands more Americans will die because they don’t have adequate medical care.
As is their custom, Democrats are blaming each other for Democrat Martha Coakley’s unforgivable loss to Republican Scott Brown in the Massachusetts Senate election. As that state’s most famous senator, John F. Kennedy, said while president: “There’s an old saying that victory has 100 fathers and defeat is an orphan.”
Pick a reason: The Great Recession and unemployment are big ones. So is a lousy Coakley campaign in a state with a poor record of electing women candidates. Don’t forget the distracted White House, where the president and his staff are in over their heads. And finally, there is the long, messy, exhausting process of trying to pass a health reform bill.
What has emerged, lying near death, is an imperfect measure, and the temptation is to just let it die. But that would be a disaster for the Democrats in more ways than one.
Not being able to pass President Obama’s keystone bill would show them as weak and incompetent. Obama would find it all but impossible to pass badly needed jobs and other economic stimulus programs as well as something to control the runaway financial industry.
Passing health reform will be very, very hard. The clearest path would be for the House to approve the Senate bill, sending it to Obama. There are other possibilities, even more difficult. But liberal and conservative House members are beginning to bail out. It will be a supreme test of House Speaker Nancy Pelosi’s strength and skill if she can keep her Democrats together through the complex maneuvering needed to save the bill.
Lost in all the analysis of the politics is the human toll of failure to pass even this weakened health bill.
A study conducted by Harvard Medical School and Cambridge Health Alliance and published last fall found that uninsured working-age Americans have a 40 percent higher risk of death than those with private health insurance. This adds up, the Cambridge Health Alliance said, to “nearly 45,000 annual deaths … associated with a lack of health insurance.”
This figure is considerably higher than previous studies.
“We doctors have many new ways to prevent deaths from hypertension, diabetes and heart disease—but only if patients can get into our offices and afford their medications,” said Dr. Andrew Wilper, lead author of the study.
Dr. Steffie Woolhandler, study co-author, said: “Historically, every other developed nation has achieved universal care through some form of nonprofit national health insurance. Our failure to do it means that all Americans pay higher health care costs, and 45,000 pay with their lives.”
That points to another flaw with what is pending in Congress. It is not nonprofit. It is a potential profit machine for the insurance companies, as it has been since negotiations on this issue began.
But killing the bill would be worse.
Unemployment is stuck at about 10 percent. Layoffs will continue. Every layoff means another person, another family will lose health insurance. Even the feeble current bill would give them speedy protection. Medicaid would be extended to the working poor, now forced to seek care in emergency rooms or community clinics. A family of four headed by a 45-year-old with an income of $28,000 a year would be eligible for Medicaid. The program is now limited to the extremely poor, the blind, disabled and those in a few other categories.
Insurance companies could no longer refuse policies to those with pre-existing conditions. They could buy insurance from “high risk” pools, with premium costs limited by the government. The arrangement would continue until insurance exchanges—marketplaces where consumers could buy policies—went into effect. The exchanges would ban abuses in cases involving pre-existing conditions. Insurance companies could not impose annual or lifetime limits on benefits, and they would not be able to rescind coverage except in cases involving fraud or “intentional misrepresentation.” The legislation would also begin to close the “doughnut hole” in Medicare drug coverage beginning in 2011.
Beyond health care, the impact of abandoning the bill would be devastating to the administration’s progressive program.
Having lost this fight, Obama would find it hard to muster a majority from his disheartened, fractious Democrats for a jobs bill or a strong stimulus package.
Conservative Democrats would not support the big appropriations needed for both of them. Nervous liberals up for election in 2010 would begin abandoning the president.
This is just what the Republicans want. They have been fighting a health reform bill because they know their victory would kill the entire Obama program, give them big gains in the 2010 election and leave the president fighting desperately for re-election in 2012.
That’s the cost of losing this health care fight.
White House / Pete Souza
A legacy hangs in the balance: Then-President-elect Barack Obama pauses for a moment to look in the mirror before taking the oath of office on Jan. 20, 2009.