The president faces his biggest test yet on health care reform — and he's got one last shot at making it work
In the end, here's what the history of this attempt to reform health care comes down to: Barack Obama did everything wrong. Instead of using his vast post-electoral capital with the public to push for real reform and clean the Augean stables of the health care industry, he and his team of two-faced creeps like Rahm Emanuel took the Beltway-schmuck route and cut a backroom deal with the targeted industries — buying their acquiescence to a theoretical future of regulatory oversight in exchange for an upfront mountain of taxpayer giveaways.
The Obama administration was willing to sell out every inch of the body politic to the pharmaceutical and insurance industries, and all it wanted in return was a single ten-dollar bill left on the night table to pay for the next day's dragon bag — a teeny-weeny token, some itty-bitty thing it could call health care reform, like a prohibition on rejecting people with pre-existing conditions. But despite prostituting itself to every industry bagman in the District of Columbia, the White House wound up getting nothing in exchange for its trouble but a congressional ass-kicking by the Republican minority.
As much as Obamacare sucks, though, the alternative is even worse. For one thing, the defeat of Obama's health care initiative would set a decisive precedent: that even a transcendently popular new president armed with a congressional supermonopoly is forbidden to so much as put a regulatory finger on an organized, politically connected industry. For another thing, Obama's pukish bungling of health care may achieve what previously seemed impossible: exhuming the syphilitic corpse of George W. Bush's Republican Party, and, shit, who knows, maybe eight years of President Sarah Palin.
There's only one way all this turns out well — and fortunately, there's a decent chance it might actually be happening. Having spent a whole year approaching health care as a corrupt, watered-down, backroom deal, Obama sent a clear signal at his health care summit on February 25th that he's finally ready to dispense with the bipartisan fantasy and pass the bill with a simple majority. It involves using a filibuster-proof budgetary procedure called "reconciliation," which requires only 51 votes — and it could produce a health care bill that would not completely and totally suck. "It's the only way," says one Senate aide.
Right-wing critics howl that using reconciliation to pass sweeping policy changes like health care is an abuse of power — the tactic, they say, is supposed to be limited to spending measures — but they're full of shit. Newt Gingrich used it to pass the Contract With America in the mid-1990s, and Tom DeLay used it to pass the Bush tax cuts in 2001 and 2003. And here's the good news: The only way to use reconciliation for health care is to get the House to sign off on the process. That means the White House, which pre-Massachusetts and pre-Scott Brown had planned to toss aside the far more progressive House bill and pass the horseshit Senate version packed with industry giveaways, now needs the votes of reform-minded congressmen like Dennis Kucinich to get health care passed. The good guys, in other words, have regained some leverage, giving them a chance to bargain for significant improvements to the shitty Senate bill. "A reconciliation bill would almost automatically be better than what we had," the Senate aide concedes.
Among the big-ticket changes being discussed are more "affordability credits" to help the poor pay for health insurance, reducing or eliminating drug co-pays for people on Medicare, and scaling back the proposed tax on high-cost plans enjoyed by union workers. There's even a very, very faint hope that a public option could be pushed through — although that would require 27 more Democrats in the Senate to grow DeLay/Gingrich-esque spleens in the next few weeks.
And therein lies the larger issue at stake. Democrats and Republicans are basically the same on a lot of issues: They both voted for the Iraq War, they both love pork and useless weapons programs, they both lift their skirts for Wall Street. But they have one major stylistic difference: Republicans are unafraid to exercise power, while Democrats try to run government like one of those pansy-ass T-ball leagues, where every kid gets to have a hit, nobody loses, and nobody has to go home with an ouchie or hurt feelings.
Well, T-ball is over. If Obama wants to pass any kind of reform — even one as riddled with industry giveaways as the current measure — he is finally going to have to take a swing in anger. If he doesn't, it may well mark the moment when our government conceded that it can never force any powerful industry to accept any kind of change, no matter how minimal. If the Democrats fuck that up, they're going to leave us living in a hell of a world for the next generation or so. Let's hope they grow some guts before it's too late.
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