Mr. President, what part of NO do you not understand?

Thursday's "bipartisan" summit was pretty much a non-event to me. We knew when Congress adjourned for its summer break last July that the Republicans were taking a fundamental opposition position toward health care reform, i.e., "just say no".

And what the Democrats need to do in the face of that opposition hasn't changed, either. They need to jam through a good health care reform with a public option with nothing but Democratic votes if they have to. Then make the Republicans own their opposition to popular and constructive programs.

I listened to most of the afternoon segment. The weirdest moment to me was one that also caught Joe Conason's attention (Propaganda meets professor at the health summit Salon 02/25/10):

The Republican attitude about these questions was summed up crisply by Sen. John Barrasso, a Wyoming orthopedist who blurted out a rather jaundiced view of his patients, and by extension the American people. It turns out that Barrasso thinks full coverage is bad, because when people have the same kind of coverage as senators do, they don’t worry enough about the costs. If they only have catastrophic coverage, according to him, then they will become better consumers.

What kind of doctor wants his patients to worry about whether they can afford the tests and treatments they might need? What kind of doctor would abdicate responsibility for those crucial health decisions to the market? It was hard not to feel sorry for Barrasso’s patients - and easy to think that they, if not the rest of us, are better off with him in Washington rather than Wyoming. [my emphasis]

As Conason observes, even Oklahoma's often-egregious Sen. Tom Coburn sounded downright sensible in comparison.

What matters now is what mattered last July: how aggressive the Democrats are in passing a good bill and how good they are in explaining their position against Republican obstructionism.

No doubt in my mind that the Democrats came off better in yesterday's confrontation than the Republicans did. Although I'd have to say that the Dems generally do a lousy job in explaining the Republicans' false claims about allowing interstate competition among insurance companies. Health insurance companies can and do sell across state lines now. The Republicans' proposal is to allow them to do so on the terms permitted by their home state, not under the rules of the state in which those buying the policies live. The purpose of that and the main effect of it would be to create a race for the bottom among the states to minimize consumer protections on health insurance policies.

Digby sensibly points out that many voters who haven't been following the health care debate as closely as us political junkies have been may not take away from Thursday's event the impression that the Republicans are being irrational obstructionists (Equally Earnest Hullabaloo 02/25/10):

The president was in command of the facts, competently defended the Democratic position and successfully batted back many of the GOPs misrepresentations. The Republicans were effective in repeating their usual talking points and non-sequitors.

However, if I were to tune in to this summit without having a fairly good grasp of the politics in play, I’m afraid I might come away from it thinking that both sides are equally earnest in trying to fix the problems with our health care system and they both have equally good ideas. After all, they told us that all day and the picture of these people all sitting around a table politely exchanging ideas creates that appearance. But the fact is that the substantive disagreements between the two parties represent more than an abstract philosophical difference of opinion. They represent a hardcore, political impasse.

Much, as always, depends on how the media chooses to frame this summit, but I’m afraid that many people are nonetheless likely to be left with the impression that problems passing this bill are the result of Democrats refusing to put all these neat Republican ideas into the mix --- and if they can just agree to do that, we can all hold hands and sing kumbaaya. [my emphasis]

The bottom line is that Obama and the Democrats have solid majorities in both the House and the Senate and a mandate from the voters to pass health care reform. If they don't get it done, they have no excuses. Loyal Democratic voters won't be switching in mass numbers to voting Republican if they fail. But for the small segment of swing voters and for the enthusiasm among Democratic base voters for going to the polls and for getting out other voters, failing on health care reform would almost certainly damage the Democrats in November's Congressional elections and probably at the state level, as well.

It also matters what kind of reform the Democrats enact. The current private-insurance-based approach of both Senate and House bills requires employer mandates to buy insurance, individual mandates, and a ban on insurance companies applying pre-existing conditions exclusions. For that to provide universal or near-universal care, control costs and protect consumers, a public option is necessary. I actually would prefer to see the bill voted down than to pass it without a public option.

This is one case where bad policy also makes bad politics, which is not always the case. If an individual mandate is passed without the public option, individual consumers could wind up being required to buy expensive insurance policies with high deductibles that for most routine medical needs would be the same as having no insurance. And we've seen how potent the insurance lobbies have been in affecting the policy debate this year and last, even before the Citizens United decision that gives corporations even more freedom to buy elected officials. The big incentive for them to support the Obama/Lieberman corporate-friendly version of reform was the individual mandate, which guarantees big new profits for them.

If the public option is left and the individual mandate is eliminated, then the Democrats would have something to bargain with the insurance giants over. If they enact the Senate version of individual mandates with no public option, the insurance lobby will have no reason to do anything but oppose future attempts to set up a public option. The public option means effective competition for them which means less freedom to rip off consumers.

Under the current approach, the individual mandates wouldn't take effect right away. So the Democrats in the short run might be able to market the Lieberman approach as providing solid health insurance reform. And the Senate bill has some undoubtedly good features like expansion of community health centers. But it gives the Republicans plenty of ways to attack it. And when the mandates kick in, if there isn't a public option or effective consumer regulation, a lot of people will have good reason to think it's a bad idea.

The Democrats need to be worrying about passing good policy, not daydreaming of a "bipartisan" love fest over this thing.

Tags: democratic party, health care reform