In a week of discouarging developments on health care reform, the House of Representatives has stepped up and offered reform advocates reason for optimism.
Today, three House committees are unveiling a draft of reform legislation they've constructed together. That sentence alone is something to savor. Committee turf battles helped kill reform in 1993 and 1994. Now we have all three committees with jurisdiction acting as one, putting forward the same piece of legislation and vowing to go forward in continuing partnership.
And it's not just cooperation among the committees. It's cooperation
among the party's factions. "While all elements of the caucus will have
problems," a senior House staffer tells me, "they all support this as
starting point." I'll try to make some calls later today, in order to
test that proposition myself.
The elements, very quickly: Subsidies up to 400 percent of poverty, expanded Medicaid eligibility, employer and indivdiual repsonsiblity (with actual details, for a change).
There's a also public plan. And it's a strong public plan. At least initially, payment rates will be pegged to Medicare, although the precise mechanism isn't clear to me.
The financing? Well, that's the catch. And it's a big one. It's still unspecified, although Energy and Commerce Chairman Henry Waxman says it will be a combination of system savings, empoyer contributions, and new revenues.
The public plan will set off opposition, surely: That sound you hear is the health insurance lobby, (some) physician organizations, and other interest groups furiously dialing their public relationships firms, to cue the attack ads. But the House leaders seem altogether ready for that fight. Indeed, the most striking thing to me right now is not so much what's in the bill but the way the committee leaders are promoting it. No hedging, no efforts to be coy about what they're rolling out.
Businesses don't want an employer mandate? Docs don't like the public plan rates? The House leaders are ready with their answers (although they're also ready with some sweeteners, like a solution for the annually scheduled reduction in Medicare rates for physicians).
Of course, it's easy to talk big when you don't have to worry about a filibuster and the wild over-representation of tiny states. And it's even eaiser when you haven't fully spelled out the financing of the plan. When it comes time to propose new taxes or spell out cuts to providers, the prevailing unity could fall apart. Just ask Democratic leaders in the Senate.
But if the House follows through with money to pay for this program--a big "if," yes--then this proposal seems eminently sensible, at least upon first inspection. And the politics may not be quite as difficult as they seem. Remember, many of the propositions that alienate special interests and conservatives happen to be pretty popular with the voters. Reform will not make it through the process in this pristine form, obviously. But a bill like this change the parameters of debate, improving the final compromise.
I've contacted about a half-dozen friendly liberal wonks in the last 90 minutes, since the draft became public. Everybody seemed pleased. (One actually said "Boffo!") It's possible that they are as desperate as I've been for encouraging news; maybe impressions will sour as a fuller picture of the House proposal emerges. But, for the moment, this seems like good news.
Update: More analysis from Ezra Klein and Karen Tumulty, who actually asked a question (a good one) at the press conference. I'll add more information as I get it. If you want to keep up, you can subscribe to my twitter feed, @jcohntnr. Just don't tell Noam.