President Barack Obama was elected with perhaps the best chance in a generation to reform America's unjust and grotesquely inefficient healthcare system. To do so, however, he'll have to conquer not only entrenched special interests like the insurance and pharmaceutical industries and the American Medical Association but also his own sentimental rhetoric about bipartisanship.
According to Washington Post columnist David Broder, "The president has told visitors that he would rather have 70 votes in the Senate for a bill that gives him 85 percent of what he wants rather than a 100 percent satisfactory bill that passes 52 to 48." That kind of talk gets a certain kind of Beltway pundit purring like a housecat on a windowsill.
It's a mistake, anyway. As the source for this heartwarming anecdote was evidently Sen. Charles Grassley, R-Iowa, who recently dispatched a peevish Twitter message complaining about Obama's "sightseeing" while visiting France to commemorate D-Day, perhaps it needn't be taken too seriously.
Possibly it's a political head-fake, with Obama appearing reasonable and accommodating in the face of GOP hysteria over "socialized medicine" and "government rationing." Here's Karl Rove writing in the Wall Street Journal: "If Democrats enact a public-option health-insurance program, America is on the way to becoming a European-style welfare state." Appearing on CBS's "Face the Nation," Senate Minority Leader Mitch McConnell, R-Ky., predicted a ruined economy with Americans needing to ask government permission to visit their doctors.
Kind of the way seniors do under Medicare, I suppose, which is basically what the "public option" consists of: an opportunity for Americans to buy into a government-run health insurance plan like that currently available to federal employees. Or to stick with whatever private health insurance program -- employer provided or not -- makes sense to them.
In a column for Politico.com, our bipartisan friend Sen. Grassley recently wrote that, should it be enacted, "As many as 119 million Americans would shift from private coverage to the government plan." That, in turn, would "put America on the path toward a completely government-run healthcare system ... Eventually, the government plan would overtake the entire market."
Translation: The public plan must be stopped because it'd be too good. Private insurance companies simply couldn't compete. Really, could they be any sillier? One minute they're yelling that Medicare costs are busting the budget; the next they're freaking out about how controlling costs will lead to rationing.
If there were any logic to the Republican position, they'd call for abolishing Medicare and Medicaid. But that would likely have the same effect on the GOP as its near-unanimous opposition to Social Security had during the 1930s, when Republican membership in the House dropped from 270 to 88. So logic be hanged.
Meanwhile, never mind that the White House has completely ruled out a British- or Canadian-style "single payer" plan, recognizing that many Americans are more comfortable with the private coverage they already have. Atlantic Monthly blogger Matt Yglesias wondered what British conservatives say about that country's National Health Service.
So here's the Tory position: "The NHS embodies something which is truly great about Britain. That something is equity: the spirit of fairness for all and the equal right of everyone regardless of age, background or circumstance to get the healthcare they need. It really is one of the most precious gifts we enjoy as British citizens ... That is why the Conservative Party has made [improving] the NHS its number one priority."
Fact is, there's not a nation on earth that's enacted universal healthcare insurance where revoking it is even an issue. Several countries -- Germany, France, Switzerland, etc. -- have mixed public/private insurance systems that cover everybody at a fraction of the U.S. cost.
As Obama pointed out in a recent speech to the Republican-leaning AMA (it opposed Medicare, too), Americans now spend, "over $2 trillion a year on healthcare -- almost 50 percent more per person than the next most costly nation. And yet, for all this spending, more of our citizens are uninsured; the quality of our care is often lower; and we aren't any healthier."
Even so, all the scare talk has Senate Democrats from the "cow states," as H.L. Mencken called them -- Max Baucus of Montana, Kent Conrad of North Dakota, and Ben Nelson of Nebraska -- proposing mushy compromises involving federally chartered co-ops, as if there weren't already co-ops aplenty among the nation's estimated 1,300 health insurance companies.
Alas, absent serious public competition and a mandate requiring citizens to buy health insurance as they do auto insurance, our present Rube Goldberg system can only get worse. "If we fail to act," Obama told the AMA, "premiums will climb higher, benefits will erode further, and the rolls of uninsured will swell to include millions more Americans."
Happy talk aside, if winning this epochal battle takes a 50-49 vote with no Republicans among the majority, then that's what it takes. Above all, Obama shouldn't negotiate with himself.
© 2009 Gene Lyons. Distributed by Newspaper Enterprise Association.
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