AP Photo/Jose Luis Magana
Sunday, Nov. 29, 2009 | 2 a.m.
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Moments after the Senate voted to open debate on its health care bill, Senate Majority Leader Harry Reid stepped off the chamber floor to take a phone call from the widow of Sen. Edward Kennedy of Massachusetts.
Vicki Kennedy was in tears as she congratulated Reid on the vote, and they both agreed that her husband, who had fought throughout his professional life for health care reform, was smiling down on the accomplishment.
Reid would not celebrate for long.
The next hurdle was obvious: The Democratic intraparty feud over the public option — the government-run insurance plan that has tripped Democrats throughout the health care debate.
In fact, Reid that night announced that several senators were working on a new version of the public plan option “acceptable to all Democrats,” different from the one included in the bill that had just been advanced by that landmark vote.
As the Senate prepares to begin its debate on health care legislation this week, the battle over the public option in many ways has become a proxy war for health care reform itself.
This despite President Barack Obama’s argument that the public option is just one element of the proposed reforms. The bill includes many other provisions, and only a fraction of the 30 million uninsured Americans could sign up for the public plan, according to an independent analysis by the nonpartisan Congressional Budget Office. (Those who have insurance offered through their employer would not be eligible.)
A generation ago the United States decided it would provide health care for its senior citizens, and agreed more recently that those who are gravely ill will not be left to die in the streets. Republicans and Democrats came together to establish Medicare for seniors in 1965 and to pass a law signed by then-President Ronald Reagan in 1986 to ensure emergency room care regardless of a person’s insurance or ability to pay.
But unlike other Western governments, the United States has not been as generous when life and death are not immediately on the line.
One reason the public option has become the focus of controversy is that it symbolizes another step toward securing health care as a right for all Americans — not just those whose jobs come with insurance or who are old enough or poor enough to qualify for government-funded care.
Democrats see in the public option an important antidote to the privately run health care system that has defined care in the United States. They believe a government-administered plan, like Medicare, would provide a lower-cost alternative and induce competition among private insurers.
Democratic Sen. Chris Dodd of Connecticut said that in this country, “certain things you ought to have a right to — not everything, just certain things ... You ought to have a right to decent health care. That’s what we’re attempting to do with this bill. That’s what we’re attempting to do for the first time in the history of our country.”
Republicans have criticized the public option as nothing short of socialism, a driving force in what they see as a big-government takeover of private insurance in the health care bill.
Former Nevada Gov. Robert List, a Republican, said last week that the nearly 500,000 uninsured Nevadans have access to health care because they can always be seen in emergency rooms.
“The public hospital treats anybody who walks in the door, in the emergency room, or claims an emergency or they need health care,” List said. “So it’s a misnomer to say these people are without health care. They may be without insurance, many of them are.”
Even among the 60 Democratic senators Reid must corral to advance the bill over the next procedural hurdles, there is skepticism over a government-run plan. A few key senators worry that the debt-strapped government would be liable for a costly new entitlement program if the public plan cannot stand on its own financially, as planned, funded only by premiums.
A majority of Americans support the public option, including a slim majority of Nevadans, according to polls.
As the Senate begins the health care debate in earnest this week, these divisions will test core Democratic beliefs and Reid’s ability to devise a compromise that can keep his 60-member caucus operating as one.
“Make no mistake, Sen. Reid, and Sen. Reid alone, controls the fate of the public option and whether or not millions of Americans get coverage without the stranglehold of big insurance corporations,” Jane Hamsher, president of the progressive Firedoglake blog, wrote in a statement. The blog’s political arm is urging Reid, if necessary, to use a procedure known as reconciliation, which would require 51 votes, rather than 60, to ensure the public option stays in the bill.
To bring the bill this far, Reid engineered a delicate balance, crafting legislation that includes a public option with an opt-out clause — allowing states to pass a law if they choose not to offer the government-run plan to their residents.
The opt-out provision was reluctantly accepted by public option supporters as a necessary compromise to advance the Senate bill.
But veteran Washington Post columnist David Broder criticized it as a bad precedent that had Reid bowing unnecessarily to states’ rights. What would have happened, Broder suggested, if landmark legislation of days past, the civil rights bills, for example, had an opt-out provision? Would segregationist states that did not agree simply opt out?
“The principle behind almost all liberal legislation is that there are certain values fundamental enough that they should be enforceable at the national level, even if a significant minority of voters or a certain number of states disagree,” Broder wrote. “No one should be denied coverage options by virtue of where they live.”
On the right flank of the Democratic caucus, the opposition could be heard on the Senate floor last weekend, just hours before the vote to advance the bill.
Sen. Blanche Lincoln of Arkansas said that although she was agreeing to open the debate, she opposed the public option in its current form. Sen. Mary Landrieu of Louisiana also raised objections.
Sen. Joseph Lieberman of Connecticut had previously said he would oppose the final bill if it included the public option. Sen. Ben Nelson of Nebraska, another pivotal conservative, also signaled early opposition.
Republicans have been almost uniformly opposed to the health care bill.
Broder suggested Democrats should instead choose the trigger proposed by Sen. Olympia Snowe of Maine, one of the few Republicans Reid continues to court to join Democrats on the bill.
The trigger as envisioned by Snowe would launch the public option in states where there is not an affordable private insurance alternative. Snowe suggests that her trigger is a way to guarantee affordable coverage even in states where governors and state legislators may keep out a public option.
Yet progressive groups dismiss the trigger, questioning, as Democratic Rep. Shelley Berkley has, why insurance companies should now be allowed more opportunities to lower costs.
“A trigger would be like saying we should give Jim Crow one more chance,” said Richard Kirsch, campaign manager for Health Care for America Now, an umbrella organization for labor and advocacy groups supporting the public option. “Anyone advocating a trigger is just trying to kill the public option.”
As Reid left the cloakroom that night after speaking with Vicki Kennedy, the next chess move in the Senate was under way.
Reid announced that several senators, including Landrieu, Sen. Charles Schumer of New York and Sen. Tom Carper of Delaware, were working on a new version of the public option, different from the one he had included in the bill that advanced with the bare minimum 60 votes.
“They’re working together to find a public option acceptable to all Democrats,” he said.
Reid has had a complicated history of his own with the public option — becoming a supporter of it, personally, but willing to negotiate with his broader caucus.
In many ways, Reid has sounded like Obama, said Sen. Jay Rockefeller of West Virginia, one of the Senate’s strongest supporters of the public option. “That’s been Harry from the beginning — he’s always said that and he’s always meant it ... Just like the president — the president is sometimes stronger, sometimes weaker” in his support of the issue, Rockefeller said, following the vote to open the debate.
Rockefeller added that talk of compromise has not deterred him from his goal of a public option.
Sen. Sherrod Brown of Ohio said progressives have made many concessions. “I will not be happy with a bill that waters this down,” Brown said after the vote.
Noting that progressive senators make up the majority of the Democratic caucus, he cautioned against making too many concessions to win the votes of the few holdouts.
Reid’s job now will be to oversee the drafting of a new version of the public option that can draw those reluctant senators aboard without losing those he already has.