Feature

Taking the health-care fight to Main Street

The battle over health-care reform shifted from Washington to Main Street this week as Congress began its August recess.

What happenedThe high-stakes battle over health-care reform shifted from Washington to Main Street this week as Congress began its August recess, with the Obama administration seeking to frame reform as a means of taming a greedy insurance industry, while Republicans claimed reform would restrict consumer choice, raise taxes, and even promote euthanasia for senior citizens. With polls showing sinking public support for President Obama’s signature issue, Republicans went on the offensive. Some House Democrats returning to their districts were met by organized protests; in Philadelphia, Health and Human Services Secretary Kathleen Sebelius and Democratic Sen. Arlen Specter were heckled and booed at a town hall meeting. “We’re going into this incredibly intense period where the fight for the hearts and minds of these members of Congress will be substantial,” said Republican pollster Bill McInturff.

Three House committees and one Senate committee have produced reform bills on Democratic party-line votes. The plans are designed to expand health-insurance coverage to nearly everyone, prohibit insurers from denying coverage, and cut long-term costs. But Republicans say the plans promote a “government takeover” of health care and would produce soaring deficits. After two White House officials declined to rule out paying for reform with middle-class tax hikes, White House spokesman Robert Gibbs said Obama would keep his campaign promise not to raise taxes on families making less than $250,000. The president, Gibbs said, is “clear about that commitment, and he’s going to keep it.”

What the editorials said“The prognosis seems to have gone from likely to dicey,” said USA Today, partly due to a “bitterly polarized” environment. Some reform opponents allege that the House bill would require elderly patients to attend sessions on “how to end their lives sooner”—a claim that’s “simply untrue.” On the other side, some Democrats pretend universal coverage and a total overhaul of the current system can be had with “no pain.” Can’t we have an “honest debate”?

Actually, the fierce political infighting is just what the doctor ordered, said The Philadelphia Inquirer. Republicans’ and Blue Dog Democrats’ concerns about costs have forced liberals to find ways of cutting reform’s total price tag. Out of this messy process a better, more responsible plan is slowly emerging.

What the columnists said “August is when reform will be won or lost,” said Jonathan Cohn in The New Republic Online. Opponents have traction, and they’ll use the recess to batter Obama’s plan. But with the debate shifting to home districts, Democrats can address the problems of “real people,” who face rapidly rising out-of-pocket health expenses and the terrifying reality that if they lose their jobs, they’ll lose health coverage. To win this battle, Obama and the Democrats need “a groundswell of support—a bigger groundswell than we’ve seen so far.”

Fat chance, said Charles Krauthammer in The Washington Post. Systemic health-care reform is dead. But while falling short of radical restructuring, Obama by year’s end will settle for insurance reform, imposing “heavy regulation” to create insurance coverage that is “secure, portable, and imperishable.” Obama will then declare this defeat a victory, and liberal pundits will “reaffirm his divinity.”

It’s hard to predict the fate of Obama’s plan—since he doesn’t have one, said Doyle McManus in the Los Angeles Times. The president left the sausage making to Congress, which “failed him.” With no “Obama-endorsed proposal on the table,” opponents are free to define reform any way they want—even as “federally promoted euthanasia.” But for good or ill, Obama’s plan will be defined this month. Whoever “best frames the debate” will win the day.

What next?Despite intense conflicts, areas of agreement are emerging in Con­gress, including bolstering competition in the insurance market, creating a government or nonprofit alternative to put pressure on insurance companies, and reducing costs in the Medicare program for the elderly. House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.), whose committee endorsed a bill last week, notes that the same committee failed to produce a bill in 1994, during the last push for comprehensive reform. “The issue is a lot more severe than it was in the 1990s,” says Waxman. Fewer interests—“doctors, patients, hospitals, or insurance companies”—are defending a status quo that is on track to “bankrupt the country.”

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