Now that the Senate has voted to vote on health care reform they can finally get to crafting a version of the measure that may actually pass. Even given the close vote in the House on their final measure it would be surprising if they chose not to agree with the version that ultimately comes out of the Senate. Nevertheless, before we get to reconciling two bills the Senate needs to find a compromise that will satisfy the current batch of fence-sitters including Joe Lieberman, Olympia Snowe, Susan Collins, Ben Nelson, Blanche Lincoln, and Mary Landrieu. By looking at their comments leading up to Saturday’s vote we can discern the nature of the compromise likely to come from the Senate (although given Harry Reid’s ability to buy Landrieu’s vote with a $300 million gift to Louisiana it may be easier than suggested). 

Joe Lieberman (I–CT) has voiced his opposition to the public option based on his overriding concern with the growing federal budget deficit. Long-term projections of budget deficits are notoriously unreliable (most short-term projections are pretty lousy too) and rarely are wrong on the side of being higher than actual results. Similarly, long-term cost estimates of government programs, and especially those having anything to do with medical costs, are equally unreliable. Says Lieberman, “I don’t want to fix the health care system in a way that creates more of an economic crisis.” Lieberman’s concerns are well-founded and I hope he continues to press the point home until more substantive steps are taken to control costs. 

Susan Collins (R–ME) is concerned that the current bill is overly focused on controlling health insurance costs and getting insurance to as many of those uninsured as possible. She wants to see greater attention paid to controlling the spiraling costs of health care which she cites as the cause of increasing and unaffordable insurance premiums. Address the costs and the insurance premiums will follow. Collins’ concerns are similar to Lieberman’s but she has noted the target of her concern more directly. If she and Lieberman can find a common ground on where and how to address cost reduction they would be a formidable team and could certainly generate support for more aggressive cost-saving measures. Unfortunately, I have not read anything that suggests where and how Collins or Lieberman would find the cost reductions that might make them more favorable toward the legislation. The change from pay-for-quantity to pay-for-quality is a terrific story but I don’t see anybody suggesting a program to get there. 

Olympia Snowe (R-ME) is well known for her objection to the public option and strongly preferring a “trigger” mechanism that would create a public option only in states where private insurance failed to meet certain coverage objectives. I don’t have a grasp of the costs associated with a public option but I suspect dropping it in favor of a trigger mechanism would provide real savings and largely keep the federal government out of the insurance business. I liked Snowe’s proposal when I first heard it and it has only grown on me since then. Collins did not join Snowe when she brought forth the proposal initially (they aren’t best buddies) but it would be interesting to see Collins and Lierberman join Snowe in fighting for this alternative. 

Ben Nelson (D-Neb.) stated he is against the public option with the opt-out clause but would consider an opt-in clause. No, this is not splitting hairs, but it certainly means that Nelson is a winnable vote for Harry Reid…maybe $100 million for the good people of Nebraska? Nelson too expressed concern with cost control but given this issue is consistent among all the fence-sitters it will inevitably be addressed. 

Blanche Lincoln (D-Ark.) is the only one of the group up for election next year and she is getting an earful from both sides. Democrats and supporters including MoveOn.org have threatened to support a Democratic challenger if she abandons them on this vote. Republicans are lined up to challenge her in a state that is generally conservative and voted overwhelmingly against Obama. But there are hundreds of thousands of uninsured in Arkansas who will be helped by insurance reform and Lincoln has been a vocal supporter of health care reform. It seems illogical for Lincoln to gum up the works when it comes time to vote but this is politics we’re talking about so… 

Mary Landrieu (D-La.) is also opposed to the public option but I have not heard any other complaints from her. It seems a removal or restructuring of the public option will assure her vote. 

So there are the fence-sitters (some may add Evan Bayh (D-Ind.) and Mark Pryor (D-Ark.) to the list). I’ve noted their major issues but of course there are many others that also need to be addressed including the abortion funding provision. Four of the six are needed to assure passage of the bill out of the Senate and surely the three Dems along with Lieberman are the likely candidates. But it seems clear that Harry Reid will need to reform the existing bill to garner the necessary support. I’d expect a bill with either Snowe’s trigger option or Nelson’s opt-in provision to become the final compromise and that, in fact, may get Snowe’s vote as well thereby giving the bill at least one Republican vote – a huge advantage going into the reconciliation process. If anyone has better information on what the cost-savings would be for the trigger versus the opt-out I’d sure be interested in hearing that to see if it makes the bill more palatable to Lieberman. 

Ultimately I’d like to see a trigger option that allows the public plan to pay Medicare rates thereby assuring real cost savings. I’d like to see the major financing come from taxing “Cadillac coverage” (as the Senate does) rather than raising income taxes on the wealthy (as the House does) because health care reform needs to self-finance and higher tax rates on the wealthy will be needed to address the budget deficit. There are probably some aspects of malpractice reform that I would find acceptable though I have major problems with the proposed $250,000 cap on punitive damages. I’d like to see a commitment to acceptance of a prescribed minimum program of care for specific illnesses in an effort to reduce unnecessary testing and unrelated overtreatment in the name of “cya” medicine. Lieberman, Collins, and company need to come up with their specific proposals to address rising costs and then everyone needs to make the American people understand that this is not a quick fix solution. I really don’t think people get that.

Tags: Ben Nelson, Blanche Lincoln, Cadillac coverage, Health Care Reform, Joe Lieberman, Mary Landrieu, Olympia Snowe, Public Option, Susan Collins, Trigger option

This entry was posted on Monday, November 23rd, 2009 at 1:21 pm and is filed under News/Politics. You can follow any responses to this entry through the RSS 2.0 feed.