Health reform: Are we there yet?

Nancy Pelosi is known around San Francisco — and in a few other spots — as one tough politician. She likes being Speaker of the House, and she doesn’t much like losing. So this week’s do-or-die health reform bill is going to get all the muscle she can manage. It is, Pelosi has declared, “a moral and political imperative.”

Okay, it’s not what we hoped, it’s too complicated and too fraught, it’s going to be full of little gifties given to get votes. If we don’t get something America will be stuck with a non-functional system and millions will remain without health care at all. So I for one am on Pelosi’s side.

The plan is for the House to pass the Senate version and send it to Obama for his signature and enactment. Certain fixes the House is demanding for passage of the more conservative Senate bill will be included in a separate, special measure that will go to the Senate for an up-or-down vote that avoids a filibuster.

But once the House passes the base legislation and Obama signs it, the measure becomes law regardless of what the Senate does.

Democrats do not yet have the votes in hand and Pelosi will not call a vote until they do. Liberal lawmakers have deep reservations about the Senate bill, and fights over abortion and immigration have yet to be resolved. But Pelosi has set the legislative train in motion, even as Republicans have publicly begun to express doubt that they can stop it.

Pelosi laid down the law to wavering Democrats who are threatening to bolt. “It’s not about abortion, it’s not about immigration,” she said. “The only reason, therefore, to oppose the bill is that you do not support health care reform.”

A lot of people don’t support health care reform. The Republicans, the insurance industry, the anti-abortion folks and the anti-immigration folks and more than a few people who feel pretty much okay with what they’ve got and frankly don’t care a lot about what others don’t have.

But health care reform is a moral imperative.

Pelosi: Dems will have votes to OK health care.

Health care reform: comatose but breathing

Virginia Governor McDonnell, who proclaimed in his rebuttal to President Obama’s State of the Union address that we have “the best medical system in the world” has my qualified agreement on one point. My personal medical system is the best in the world. As a member of Kaiser Permanente, I consider my physicians among the best in the world and my care right up there. I can e-mail any of my physicians with any question; most of them reply in 24 hours or less. I can schedule appointments with specialists with ease; usually I see anyone I want within a few weeks. Medicare helps me pay for all this.

Problem is, not everyone in America enjoys such care at such cost. Millions of my fellow Americans – who might not agree with Governor McDonnell – would be happy for any kind of medical care at any remotely affordable cost. Millions of Americans are suffering and dying for lack of care. Maybe, to correct this, I’ll have to settle for just moderately excellent care rather than the best. So be it. Maybe my costs would go up. So be it. It is morally wrong for people in this country to be without health care.

(In a recent comment on this page written very late at night I attributed Governor McDonnell’s interesting phrase to former Virginia Governor Tim Kaine. Even before my astute True/Slant editors had caught the gaffe an astute reader had brought my attention to it. After I thanked him, Astute Reader replied, “Virginia might be better off if you did give it back to Tim Kaine.” We’ll see.)

But back to health care. Although it has faded slightly into the background, word is that House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid are still hoping to salvage the sprawling bill. It could be done, if the Senate bill’s sprawl. As Noam Levey reported in Sunday’s Los Angeles Times,

(I)n the coming weeks, Pelosi and Reid hope to rally House Democrats behind the healthcare bill passed by the Senate while simultaneously trying persuade Senate Democrats to approve a series of changes to the legislation using budget procedures that bar filibusters.

At the same time, leading consumer groups, doctors and labor unions that have backed the healthcare legislative effort for more than a year are stepping up attempts to stiffen lawmakers’ resolve.

These included scaling back the Cadillac tax, boosting aid to help low- and moderate-income Americans buy insurance, closing the “doughnut hole” in the Medicare prescription drug plan, and giving all states the assistance that Nebraska secured to expand Medicaid.

But many House Democrats do not want to vote on the Senate bill until the Senate passes the fixes they want. And it is unclear whether the Senate could approve a package of changes to its bill before the House approves the underlying legislation, according to senior Democratic aides. Democratic leaders hope to agree on a procedural path forward by the end of this week.

Despite the hurdles, there is a growing consensus that a modified Senate bill may offer the best hope for enacting a healthcare overhaul.

“The more they think about it, the more they can appreciate that it may be a viable . . . vehicle for getting healthcare reform done,” said Rep. Gerald E. Connolly (D-Va.), president of the Democratic freshman class in the House.

Sen. Tom Harkin (D-Iowa), who chairs the Senate health committee, noted that even before the Massachusetts election, senior Democrats had substantially agreed on a series of compromises that addressed differences between the House and Senate healthcare bills.

This space still hopes that “the best medical system in the world” can be made available to a few of the millions in America who still so desperately need it.

Obama, Pelosi & the health bill yo-yo

Invoking the not-so-long-ago proposals of Senators Bob Dole and Howard Baker, President Obama told the Republicans Friday that his health bill is “pretty centrist,” while suggesting they might leave off referring to it as a Bolshevik plot. “People in America don’t believe it’s centrist,” Congressman Jeb Hensarling (R-TX) told PBS NewsHour‘s Judy Woodruff just after the event — “the government defining costs, benefits…”  Hensarling did not sound much like someone ready for bi-partisan cooperation.

House Speaker Nancy Pelosi, meanwhile, said yesterday, in a letter e-mailed to constituents, that “Congress will pass health insurance reform no matter what barriers stand in our way. We will go through the gate. If the gate is closed, we will go over the fence. If the fence is too high we will pole vault in. If that doesn’t work, we will parachute in.” And therein may lie the problem: Obama’s move from health care to jobs as number one issue, and Pelosi’s, well, Pelosi-like determination to get some sort of a health bill through, no matter what. Some of us who agree that jobs and the economy are admittedly number one still believe the disaster that is our current health care system has got to be addressed. (One wonders what planet Virginia Governor Bob McDonnell lives on, commenting during his rebuttal to the State of the Union address that Americans don’t want to mess with “the best medical care system in the world.”)

Health reform, whatever remains of it, has become the yo-yo of the year: it’s up, it’s down, it’s tangling in multiple strings, and the axle connecting it between Democrats and Republicans looks more worn with every loop.

Here are a few of the assessments Friday night pundits were making: New York Times reporter Peter Baker on Washington Week in Review: “It’s become bad politics. There is no option but to slow down.” Also on Washington Week, Politico‘s John Harris remarked, “It’s comatose.”

The President did himself proud with the Republicans, in what was indeed a remarkable event, even if no immediate good will arises. It felt downright civil. But as to the health care yo-yo and whether it now rolls quietly under the sofa to rest a while, a parting thought came from columnist Mark Shields on NewsHour. “President Obama,” he observed, “doesn’t control Nancy Pelosi.”

Pelosi keeps public — and her own — options open in San Francisco talk

House Speaker Nancy Pelosi rallied the faithful in San Francisco Saturday afternoon, drawing the loudest applause (there had already been cheers for heavy-hitter Democrats, San Francisco liberal causes and hometown heroine Pelosi herself) with an assertion that passage of the health reform bill will happen soon. She said the House bill is the stronger,  and negotiations to reconcile House and Senate versions into a final bill “are intense.”

Whether that final bill will include the public option her audience of several hundred supporters clearly wanted remains in doubt – and Pelosi was keeping her own options open. “Any bill we approve will have to pass the Triple A test,” she said: “Affordability, specifically for the middle class, Accountability – insurance companies will have to be held accountable; and Accessibility.”

Accessibility, of course, brings the issue back to the public option, which the bill will have, Pelosi maintained, “…or what the public option was intended to do: keep the insurance companies honest.”

The invitation-only Saturday event was billed as a New Year Celebration, and held on the first anniversary of a similar gathering hailing her ascension to Speaker last year.  Both took place at Delancey Street, a residential self-help community founded in 1971 to help substance abusers, ex-felons and “people from America’s underclass” get back on their feet and into productive lives. A few of the 14,000+ who have graduated from Delancey Street programs mingled with the likes of former state senator and current California Democratic Party Chairman John Burton, prominent gay California State Senator Mark Leno, and San Francisco Mayor Gavin Newsom. Almost anyone who is, or aspires to be, anyone in local Democratic politics was working the room.

Pelosi worked it herself, smiling and greeting her way through the crowds for several hours. When she returns to Washington after this weekend at home, the greetings and workings are guaranteed to be a little more fractured.

How public is your option?

Not very, in all probability.

According to current reports, only those whose coverage exceeds 12.5 percent of their income, only the smallest businesses, or those who aren’t covered by Medicare or VA programs… a very few onlies will have access to the public option. Still, the public option is less important than the reform bill itself. We may have reached the point at which the perfect is indeed the enemy of the good.

Early on in this process my friend Catherine Dodd, whose extensive health policy credentials include stints on Nancy Pelosi’s staff and as a Regional Director for the Department of Health and Human Services, advised an audience inundated with numbers and percentages and data to remember just one figure: “Nineteen point seven,” she said. It has taken an average of 19.7 years after one health reform measure failed to raise the issue again.

Many of us do not have another 19.7 years to wait for the next battle.

Public option still alive: believe it…or not

The fact that there are still believers in the public option, and its inclusion in whatever health bill eventually survives, may say more about the believers than the belief. But Nancy Pelosi hasn’t yet caved, and a few among the many who see this as the only way real reform will happen are still betting on it. Two of those are strategic technology consultant Robert Weiner and his research chief Rebecca Vander Linde who penned an op ed in the San Francisco Chronicle Friday. I’m not a gambler, but I cheer their position.

Opponents’ caricatures have become commonplace – the Republican National Committee video puts House Speaker Nancy Pelosi side by side with James Bond’s villainess, Miss Galore. The Iowa Republican, a party newsletter, on Sept. 18 called Pelosi “inept at her job.” Actor and former Sen. Fred Thompson labeled her “naive.” On Sept. 10, master Republican strategist Karl Rove asked, “How much capital will Speaker Nancy Pelosi have” to pass health care?

Pelosi answered that in a conversation Sept. 29 at House Judiciary Committee Chairman John Conyers‘ 80th birthday party, after the Senate Finance Committee had just rejected the Medicare-like public option for all by a 10-13 vote: “We will not be deterred. We will pass the bill.”

The public option is still viable. The House is set to pass it. It is neither “fading” nor “waning” (New York Times) nor on “life support” (ABC News).

Citing a recent CBS News poll that showed public support for the public option rose from 57 to 68 percent after President Obama’s speech to Congress in September, Weiner and Vander Linde argue that keeping it is the only way to “counter the insurance stranglehold” that makes our current system so dysfunctional — and that Pelosi will keep it in the blended version of the three House bills and eventually see it through.

For those who doubt Pelosi’s ability to pass the bill, know that she has passed every bill she has brought forward, usually with 60-plus margins, since the Democrats recaptured the House in 2006. These include the Recovery Act, Credit Card Bill of Rights, Homeowner Affordability, Lilly Ledbetter Fair Pay, Troubled Assets Relief Program (TARP) and State Children’s Health Program expansion to 11 million youths.

About the Senate…

Senate Finance Chair Max Baucus, D-Mont., said he could not vote for the public option because “I can’t see how we get to 60 votes.” The Constitution and the law require only a majority 51. The Senate amended its rules to require a “supermajority” to end debate. This procedure, called cloture, is a pander to allow special-interest contributors (Baucus has a million dollars from insurance companies) to block bills. Pelosi is right to support Senate “reconciliation,” which would allow a simple majority to pass health reform Americans want.

We believers may turn out just to be dreamers, but we’re still sending e-mails to Speaker Pelosi.

via Public option still alive – believe it.

Will Anti-Abortionists Sink Health Reform?

Already the right wing, Catholic officialdom and Sarah Palin have won their battle to make sure that I, and countless other millions, will likely die only after expensive, prolonged, futile, aggressive, undesirable treatment rather than peacefully at home as I choose. Now they want the generations younger to be sure that any accidental, criminal or otherwise unplanned pregnancy results in another unwanted child coming into this overpopulated world. An assault on health reform is their latest battleground. I am careful to say Catholic officialdom, because all of the lay Catholics I know, many of them Good Catholics, support both reproductive and end-of-life choice. I am careful to mention Sarah Palin just to prove I have absolutely no resentment over the fact that whereas I can’t interest publishers in my several excellent book projects, she has a planned first run of 1.5 million on her dashed-off memoir.

But back to the problem at hand. Writing in Tuesday’s New York Times, David Kirkpatrick presents the new scary problem:

As if it were not complicated enough, the debate over health care in Congress is becoming a battlefield in the fight over abortion.

Abortion opponents in both the House and the Senate are seeking to block the millions of middle- and lower-income people who might receive federal insurance subsidies to help them buy health coverage from using the money on plans that cover abortion. And the abortion opponents are getting enough support from moderate Democrats that both sides say the outcome is too close to call. Opponents of abortion cite as precedent a 30-year-old ban on the use of taxpayer money to pay for elective abortions.

Abortion-rights supporters say such a restriction would all but eliminate from the marketplace private plans that cover the procedure, pushing women who have such coverage to give it up. Nearly half of those with employer-sponsored health plans now have policies that cover abortion, according to a study by the Kaiser Family Foundation.

Never mind that Obama has promised that no federal funds will go for elective abortions, and the current policies would remain unchanged, here is a handy opportunity to make points with conservatives and throw a monkey wrench into the works of reform.

Lawmakers pushing the abortion restrictions say they feel the momentum is on their side, especially because the restlessness of other Democratic moderates is making every vote count.At least 31 House Democrats have signed various recent letters to the House speaker, Nancy Pelosi, urging her to allow a vote on a measure to restrict use of the subsidies to pay for abortion, including 25 who joined more than 100 Republicans on a letter delivered Monday.

Representative Bart Stupak of Michigan, a leading Democratic abortion opponent, said he had commitments from 40 Democrats to block the health care bill unless they have a chance to include the restrictions.

So it’s all about halting abortion — maybe — or all about halting reform — maybe — but some of us who simply, desperately, wish better care and a few decent options for our less-advantaged citizens are left to wonder what it’s really all about.

Abortion Fight Complicates Debate on Health Care – Readers’ Comments – NYTimes.com.

Pelosi's Plea for Calm

However you feel about Nancy Pelosi’s performance as Speaker of the House so far, or however much you agree or disagree with her views, yesterday’s comment (as reported by San Francisco Chronicle Washington staffer Carolyn Lochhead) is worth both consideration and support.

For the first time anyone can remember, House Speaker Nancy Pelosi teared up at a news conference Thursday morning in response to a question about the current state of political discourse.

Visibly struggling to retain her composure, Pelosi recalled a time in San Francisco when emotions ran out of control, referring to the 1978 assassination of Mayor George Moscone and Supervisor Harvey Milk by former Supervisor Dan White.

“We are a free country, and this balance between freedom and safety is one that we have to carefully balance,” Pelosi began. She then became emotional as she recalled the events, startling the reporters gathered for the weekly news conference.

“I saw this, myself, in the late ’70s in San Francisco,” she said. “This kind of rhetoric was very frightening and it created a climate in which violence took place.”

I was not it San Francisco at the time, but those who were affirm that the intensity of anger, fear and hostility abroad in the community at large offered the ground out of which such an appalling act could grow. Many say the movie Milk accurately caught that mood, and watching the movie made my heart rate accelerate. I don’t think we need any more heart rate acceleration in the U.S. right now.

Regaining control, (Pelosi) expressed a wish that “we would all, again, curb our enthusiasm in some of the statements that are made” and “take responsibility” for what is said.

Those of us who have lived through other periods of polarization in this country — the McCarthy witch hunts, the Vietnam war, the battles for civil rights — retain vivid memories of too many brutalities, assassinations and cruelties. Pelosi is right about the need to retain a balance between freedom and safety. Unless we return to some semblance of civility in the public discourse we stand the chance of losing either, or both.

via Emotional Pelosi urges civility in discourse.