Medical Mandate

“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.”

—David Broder, Washington Post, June 11, 2009

IS PRESIDENT OBAMA GOING to engage on health care? Twenty-two senators from his party are obstructing one critical piece of his reform package: a public, or government-run, insurance program that would compete with private insurers. The former senator he couldn’t get confirmed as secretary of Health and Human Services is promoting a compromise that would ensure the continued dominance of private health-insurance conglomerates. And the former governor he should have appointed secretary of Health and Human Services has become one of the country’s most relentless advocates of genuine health care reform.

At a June 23 White House press conference, ABC news reporter Jake Tapper asked if a public insurance plan was non-negotiable. Obama’s response was cautious, even if he later defended the concept and ridiculed insurance lobbyists who predict that it will usher in the end of the world as we know it:

“We are still early in this process so we have not drawn lines in the sand.”

Lines in the sand? They were drawn months ago.

In March, America’s Health Insurance Plans (AHIP) president and CEO Karen Ignagni told a National Journal health-care panel that a public plan is “a red line for insurance reform.” In April PhRMA president Billy Tauzin said that the public insurance option is where the big pharmaceutical lobby will “draw a line in the sand.”

The American Medical Association (AMA) has been on record as opposing public insurance since the reform debate began, even if AMA president James Rohack has yet to come up with his own “line” metaphor. (“Line in the dirt” is still available.)

On the same day in June that President Obama refused to draw his line in the sand, Ignagni was doubling down on the issue, warning Senator Ted Kennedy (D-MA) not to replicate the public option included in the 850-page bill that had cleared House committees during the previous week.

“A government-run plan, no matter how it is initially structured, would dismantle employer-based coverage [and] significantly increase costs for those who remain in private coverage,” Ignagni said in a letter to Kennedy. She was joined by Blue Cross Blue Shield Association president Scott Serota. Having lost the fight in House committees, the industry is shifting its focus to the Senate committees that will be working on health care reform through July.

So how to explain Tom Daschle? The former Democratic Senate minority leader, whose appointment as Health and Human Services (HHS) secretary was undone by his unfortunate Internal Revenue Service history, declared that the public insurance option will never pass in the Senate, and has been promoting state-regulated insurance co-ops as a more moderate approach. Daschle has thrown in with incrementalists Bob Dole and Howard Baker, two former Republican leaders in the Senate.

It was left to former Vermont Governor Howard Dean, whom Obama never considered a serious candidate for HHS secretary, to lead a national campaign to pass a comprehensive health care plan that would include a public insurance option. Dean’s Democracy for America advocacy group maintains a running count of members of Congress who support or oppose the public insurance option. In the final week of June, Capitol Hill was aswarm with Stand With Dr. Dean activists.

NAMING NAMES—It is in the Senate, where Republicans can use the filibuster to kill almost any legislative initiative, that a public insurance program is most likely to die. Yet Senate Republicans might not need to filibuster. As we go to press, Senate Majority Leader Harry Reid (D-NV) is one of twenty-two Democrats whom Dr. Dean has identified as undecided or opponents of a public insurance plan. Names are posted on Dean’s website: https://standwithdrdean.com.
On the list with Reid are: Max Baucus (MT), Evan Bayh (IN), Mark Begich (AK), Michael Bennet (CO), Robert Byrd (WV), Maria Cantwell (WA), Thomas Carper (DE), Kent Conrad (ND), Byron Dorgan (ND), Dianne Feinstein (CA), Kay Hagan (NC), Herbert Kohl (WI), Mary Landrieu (LA), Blanche Lincoln (AR), Ben Nelson (NE), Bill Nelson (FL), Mark Pryor (AR), Jon Tester (MT), Mark Udall (CO), Mark Warner (VA), and Ron Wyden (OR).

Connecticut Independent Joe Lieberman, who caucuses with the Democrats, also opposes the public option.

The Senate’s other Independent, Vermont socialist Bernie Sanders, who also caucuses with the Democrats, is supporting the public insurance option. No surprise there. Sanders has been a fierce advocate of a single-payer system, introducing a single-payer bill in the Senate and maintaining a single-payer petition on his Congressional home page.

Constituents are far ahead of their elected representatives on this issue. At the end of June, a New York Times poll found 72 percent of Americans in favor of a government-run health insurance program. Fifty percent of self-identified Republicans polled also supported the measure.

IT’S ALL WE GOT—The public insurance option reminds me of a Thatcher Longstreth political rally I attended in Philadelphia in 1971. The patrician Mainline Republican, who was running against thuggish (and racist) former police commissioner Frank Rizzo, got an unenthusiastic endorsement from an African-American woman who introduced him to the largely Democratic crowd.

“Thatcher Longstreth ain’t much,” the woman said. “But he’s all we got.”

The public insurance option is far from perfect. It’s not a single-payer, universal-coverage system, whose advocates have been shut out by the Obama administration and the Democratic leadership in Congress. But right now, it’s all we got.

A public insurance program is the only policy option that the health insurance industry truly fears. Yet it’s a long way from the program that—AHIP spokesman Robert Zirkelbach warned in these pages back in May—would allow the government to dominate the market and put private insurance companies out of business.

It’s entirely possible that a public insurance program would become what auto insurers call a “risk pool,” in which less profitable individuals are aggregated. By what is described as “adverse selection,” those with serious health risks would end up in the public plan, leaving healthier individuals in private plans.

Despite its weaknesses, public insurance would provide affordable coverage to another pool: uninsured workers who are either self-employed or whose employers don’t provide health insurance.

There is another public benefit. Operating without advertising, market research budgets, or shareholder demands to maximize profit, a government-run program would provide what Families U.S.A.’s Ron Pollack describes as “benchmark costs” of medical care, cost figures not available today because the private companies that dominate the market claim a proprietary right to such information.

Government-run insurance would also provide competition, anathema to the big private insurance companies.

CIRCUS MAXIMUS—The big obstacle in the Senate (beyond the intransigent Republican caucus and compromised Democrats) is Finance Committee chairman Max Baucus (D-MT). Baucus has said he is determined to get a bipartisan bill out of his committee, one of two Senate committees with central roles in drafting health care legislation. The other is the more liberal Health, Education, Labor and Pensions Committee, chaired by Ted Kennedy (who is on the sidelines being treated for brain cancer).

Baucus is willing to forego public insurance if it will assuage the concerns of Senate Republicans. And Senate Republicans have concerns. The ranking minority member on the committee Baucus chairs, Iowa Republican Charles Grassley, has said he will not support a public plan because eventually it will “take over the market.” Minority Leader Mitch McConnell (R-KY) has warned that Senate Republicans will vote as a unified caucus against the public insurance option. South Carolina Republican Lindsey Graham, who must spend more time in Sunday news-program green rooms than he does in the Senate, argues that the public option “needs to go away.” Bipartisan legislation, in this climate, means capitulating to Republicans.

Baucus also told the New York Times that he wants to do something historic regarding health care reform. He already has. In 2003 he was one of two Democratic senators whom Republicans allowed to participate in a conference committee working on George W. Bush’s $400 billion Medicare prescription drug benefit bill (a bill that was written by pharmaceutical lobbyists; prohibits the government from using mass purchasing power to negotiate lower drug prices; and makes it illegal for Americans to buy cheaper prescription drugs manufactured in the U.S. and then re-imported from Canada or Mexico).

The Senate Republican leadership also permitted Louisiana Democrat John Breaux to participate—while excluding Ted Kennedy, who sat on one of the authorizing committees, and then-Minority Leader Tom Daschle. Republican leaders in the Senate considered Baucus and Breaux housebroken and unlikely to get in the way.

So unless he intends to redeem himself, Max Baucus has already had his historic (and bipartisan) health-care reform moment. He was the only Democrat George W. Bush thanked when he signed an utterly flawed Medicare prescription drug bill into law on December 8, 2003.

There is a powerful lesson in that historic moment. Democrats, then in the minority, were barred (actually escorted out by Capitol police) from the House committee meeting where the prescription drug bill was finalized. Republican Majority Leader Tom DeLay held a vote open for almost three hours, ignoring House rules that limit votes to fifteen minutes. President Bush and Vice President Cheney phoned members on the floor as they were voting. And the Senate Republican leadership carefully choreographed the Democrats they allowed to participate in the process.

I watched that process and found the procedural Stalinism to which Republicans resorted odious (and probably illegal). Yet there was something admirable about a president and a Congress uniting behind legislation they believed in and doing what had to be done to get it passed.

WHEN PIGS FLY—Dick Cheney holds the record for firing Pentagon brass—not as vice president but as secretary of defense. Shortly after he was sworn in as George H.W. Bush’s “SecDef” in April 1991, Cheney got the official word that there would be further delay in delivering the Navy’s A-12 fighter jet—already eighteen months behind schedule and $1 billion over budget.

As quickly as he would shoot Harry Whittington in the face fifteen years later, Cheney took aim at Vice-Admiral Richard Gentz. After firing the three-star admiral directing the program, Cheney reassigned two senior officers working on the A-12 project.

Okay, it wasn’t Harry Truman calling Douglas MacArthur home from Korea. But with only a month on the job, Cheney made it clear that he was the boss.

So what’s up with SecDef Robert Gates?

More than two months ago Gates announced that he and the president had decided to end production of the F-22.

Over budget?

The “advanced tactical fighter” that was sold to Congress in the 1980s at $35 million a copy today costs $185 million. Factor in years of research-and-development spending and the real dollar cost of a 2009 model F-22 is $350 million.

Behind schedule?

The aircraft was put in the weapons-system pipeline to fight Soviet jets, which haven’t been a threat to this country since the Soviet Union collapsed in 1991.

No F-22 has flown a combat mission in Iraq or Afghanistan (or in fact anywhere else). So the tactical fighter known as the “Raptor” was low-hanging fruit for Gates.

Unlike old soldiers, weapons systems don’t fade away. In June an Air Force four-star challenged Gates’ decision to build only four more of the fighters and stop production at 187. “A fleet of 187 F-22s puts execution of our current national military strategy at high risk…,” said General John Corley.

Corley is the chief of the Air Combat Command. He wasn’t exactly speaking out on his own. He was responding to an inquiry from Senator Saxby Chambliss, the Georgia Republican who has been pimping for F-22 contractor Lockheed Martin since he was elected to the Senate in 2006. He had only been in office for six months when defense watchdog Winslow Wheeler caught him lifting a paragraph from a Lockheed background paper on the F-22 and inserting it, word for word, as an amendment to a Senate bill.

Chambliss was protecting a pork-barrel project in his state, home to Lockheed’s largest F-22 assembly plant.

When it comes to the F-22, Chambliss still won’t take no for an answer. A week before he prodded Corley into a public statement, Chambliss asked Air Force Major General Marke Gibson how Europe could be protected without F-22s, which are deployed in Asia. (Isn’t there some country in Europe that can protect Europe?)

Gibson responded that the F-22 is “a deployable asset” that can be moved to “locations of stress” when needed. Chambliss paraphrased the general’s response and repeated it back to him.

“We’re either going to sacrifice Asia or we’re going to sacrifice Europe,” Chambliss said, “because we simply don’t have enough F-22s in the pike to cover both of them.”

Unable to get Gibson to salute, Chambliss settled on General Corley as “the uniform” to advance the argument that by capping F-22 production at 187, Gates is putting our nation’s defense at risk. Dick Cheney would have frog-marched the general into early retirement. Gates has yet to act.

The Senate might get a crack at the issue later.

The F-22 got its latest reprieve in the House, where Utah Republican Rob Bishop added an amendment to a defense appropriation bill moving through the Armed Services Committee. By a 31-30 vote the committee approved Bishop’s amendment to set aside $369 million to buy the parts to build twelve more fighters. The $369 million will be transferred from funds set aside to clean up toxic sites at military bases.

Bishop cited jobs—but above all “defense of the country”—to justify continued production of the F-22.

The truth lies in another amendment, which Connecticut Democrat Joe Courtney sold to the Armed Services Committee. Courtney’s amendment gives the secretary of defense thirty days to draft a report on “the cost of developing an exportable version of the F-22 to sell to the government of Japan. (Thus far no one is proposing selling the fighter to private parties.) Point 4 in Courtney’s amendment makes its intent clear:

“The study will focus on ‘the impact of foreign military sales of the F-22A aircraft on the United States aerospace and aviation industry and the benefit or drawback such sales might have on sustaining such industry….'”

The congressman was refreshingly honest in a press release describing the amendment. “We have a workforce in Connecticut and across the United States that is ready to produce modified F-22 fighters for Japan,” Courtney said.

Not a mention of the F-22 and national defense.

Oink! Oink! ????!