Public Comment

Recently, Senate majority leader Harry Reid indicated that health care reform might not be passed this year. Why? Because he may not have the votes in the Senate to pass the legislation and, if such legislation were passed, it might not survive a Republican filibuster. 

Many have criticized Reid’s and House Majority leader Nancy Pelosi’s handling of health care reform. As the argument goes, we have a Democrat-controlled Congress, so forget the Republicans and pass a health care reform bill without them. But that argument does not take into consideration the conservative Blue Dog Democrats in both Houses, who largely control the debate. What’s the difference between a Blue Dog Democrat and a Republican? Not much, I guess. 

Blue Dog Democrats 

Presently, there are 435 Representatives with 257 Democrats and 178 Republicans. Of the 257, 56 are a coalition of conservative Blue Dog Democrats, and without them, the Democrats do not have a majority.  

In the Senate, there are 58 Democrat Senators. Joe Lieberman and Bernie Sanders are officially listed as Independent but usually caucus with the Democrats, giving them 60 votes. Of these, there are 15 to 20 Blue Dog Democrats. Without them, the Democrats do not have a filibuster-proof majority. And Senator Joe Lieberman recently said he would join a Republican filibuster of any health care legislation that includes a public option, leaving the Democrats one short to defeat a filibuster. That, of course, assumes that all the Blue Dog Democrats vote for a health care reform bill, which is not at all certain. Clearly, the Blue Dogs control the issue in both houses of Congress. 

Cost control 

Important objectives of meaningful health care reform are cost control and to provide health care for the approximately 45 million Americans without health care. The Blue Dog Democrats ostensibly focus on deficit reduction and fiscal responsibilty. These Democrats are especially concerned, as we all are, about the cost of health care reform. Presently, we have a $1.4 trillion deficit and the ten-year deficit is estimated to reach $9.05 trillion. Representative Pelosi claims that the House version of the legislation will cost $900 billion over ten years. The priorities of the House Blue Dogs are to keep the cost under $900 billion and to get a 20-year cost estimate from the Congressional Budget Office. If and when hearings begin, skeptical Representatives will focus on the legislation’s cost and who’s going to pay for it.  

Public option 

The health insurance industry enjoys obscene profits, while consumers pay more for less coverage. Profits at ten of the country’s largest publicly traded health insurance companies rose 428 percent from 2000 to 2007. One of the main reasons for such high profits is the growing lack of competition in the private health insurance industry, which has led to near-monopoly conditions in many markets. 

Any comparative analysis of health care systems indicates that the greater the role of private, for-profit health insurance companies in the delivery of health care, the higher the cost. This is why the United States has the most expensive health care system in the world but trails well behind on crucial indicators of public health, such as infant mortality, longevity, and death of women in childbirth. These facts provide compelling evidence for the inclusion of a public option in any health care reform legislation to provide some healthy competition, which in turn will bring down costs and provide the greatest amount of choice possible for consumers. 

Without a public option, more people will have health coverage, but it will do little to rein in the spiraling cost of health care. Giving consumers the choice of an efficient, nonprofit, government-run insurance plan similar to our Medicare or to the single-payer plans enjoyed by Australia’s Medicare, Canada’s Medicare, the United Kingdom’s National Health Service, and Taiwan’s National Health Insurance would move us toward real cost control. Unfortunately, the votes simply are not there in either the House or the Senate for a single-payer plan.  

In an Oct. 21 Gallup survey, 50 percent of respondents thought a health care bill should include a public, government-run insurance plan to compete with private insurance companies. Forty-six percent thought it should not. These poll results encouraged the Senate leadership to include a public option with an opt-out provision for states. Under this concept, states would be able to determine whether the public option works for them and would have the ability to opt-out. Up until this point, it was thought that any public option was dead in the water. 

The next step in the legislative process would be to send the new merged language to the Congressional Budget Office for analysis. When the CBO has finished scoring the combined Senate bill, it would be brought to the floor for an open debate and amendment process. That would leave the Senate and the conference committee between the two chambers as the final battlegrounds for the public option. There appears to be no opposition to this public option in the House, including among the Blue Dogs. 

Finally, Representative Dennis Kucinich introduced an amendment calling for a state single-payer option, which would protect the right of states to pursue a single-payer health care system. The House leadership rejected his amendment. Once the health care bill passes the House, and the Senate passes its version, the two bills will go to a conference committee. Kucinich hopes at that point that the amendment will be included in the conference committee report, since that is what would ultimately become law. Unfortunately, this is an unlikely scenario.  

A health care plan with any kind of public option is still far from certain in the Senate, and, even if one passed in the House and Senate, Senator Lieberman may be in a position to kill the legislation by joining a likely Republican filibuster. The Republicans will probably stand united against any Democrat-sponored bill even one without a public option. They do not want to give President Obama and the Democrats any political advantage, especially with mid-term elections just around the corner. 

Ralph E. Stone is a retired Bay Area attorney.