Health reform advances with Democratic deal

What happened

Following a rare weekend session highlighted by a pep talk from President Obama, Senate Democrats moved closer to passing sweeping health-care reform, reaching a compromise on publicly financed insurance plans that would extend Medicare coverage to millions of Americans. Under the deal reached by the so-called Gang of 10 liberal and moderate Democrats, the government would negotiate national, not-for-profit insurance plans run by private insurers. Those plans would replace the government-funded insurance program, or public option, contained in the House-passed plan and in earlier Senate versions. The measure, which mandates insurance for most Americans while offering subsidies to poorer citizens, would permit people between ages 55 and 64 to buy Medicare coverage, now available only to those 65 and older. The agreement “moves this bill way down the road,” said Majority Leader Harry Reid.

But the fragility of the Democratic consensus was made clear when the Senate voted 54–45 to reject an amendment by Nebraska Democratic Sen. Ben Nelson that would have barred federally subsidized health plans from covering abortions. Nelson hinted that he might now oppose the measure. Because the Democrats need 60 votes to block any Republican filibuster, Reid would then need to win over one or two Republicans, most likely Maine Sens. Susan Collins and Olympia Snowe.

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What the editorials said

The Democrats have stepped all the way through the looking glass, said The Wall Street Journal. The Congressional Budget Office has concluded that the Senate bill would drive insurance premiums higher. But Democrats claim that “these higher premiums don’t count because they will be offset by new government subsidies.” The sleight of hand doesn’t stop there, said the Charleston, S.C., Post and Courier. The only way Democrats can keep their plan from adding to the exploding deficit is to cap Medicaid and Medicare reimbursement rates. But they know that future Congresses will increase them. This “legislative gimmick” resembles “the three-shells-and-a-pea game played by hustlers upon the guileless.”

At least Democrats are confronting “the central question of controlling health-care costs,” said The Washington Post. The nonprofit plans and expanded Medicaid coverage could force insurers to compete on price. Another promising fix would create pilot programs to “pay some providers based on the quality of their performance,” rather than the number of procedures they perform. There are finally some “hopeful signs” that our leaders are getting serious about facing the nation’s health-care crisis.

What the columnists said

Too bad it’s taxpayers who will foot the bill, said Paul Howard in National Review Online. Even without the public option, the Senate bill is bound to send costs through the roof. Unable to resist pandering, Democrats want to expand coverage for long-term care and lavishly subsidize individual policies. Make no mistake, they are pushing “a costly expansion of the welfare state, with no real strategy for reining in costs.”

On the contrary, said David Leonhardt in The New York Times, Congress “may be summoning the political courage” to slash wasteful health-care spending. Every time somebody puts forward an idea—whether it’s taxing the costliest plans or curbing Medicare—“the cry goes out: Patients will suffer!” Surprisingly, though, several cost-cutting provisions have survived and could be enacted. “Cost control is not, in fact, all pain and no gain,” said Ezra Klein in The Washington Post. Historically, workers’ wages rise when premiums paid by their employers fall, and vice versa. To overcome the doubters, Democrats could make the case that cost control means “some pain in return for a fat raise.”

For President Obama, the stakes could not be higher, said E.J. Dionne, also in the Post. “If Obama gets to sign a health-care bill before he gives his State of the Union address,” he would start 2010 with a “historic victory” that would boost the rest of his domestic agenda, from job creation to curbing greenhouse gas emissions. In his recent Afghanistan speech, Obama said that nation-building must begin at home. “Health-care reform would markthe beginning of domestic nation-building.”