Point Austin: Health Care Is the Least of It

If you're unsure where you stand on the epic national health care debate, you're not alone. Austin Congressman Lloyd Doggett has been in the middle of the discussion for months, and he told me this week during his stay in Austin that he remains uncertain whether he'll be able to vote for passage of a final bill. "In terms of whether anything is salvageable," Doggett said, "I would just say I am not committed to vote for this bill yet, until I see what it is. I don't believe that 'any bill is better than no bill.' The Senate bill, the more I hear about it ... it certainly tests to the very outer limits my willingness to vote for it."

When we last left this argument, just before Christmas, a recalcitrant Senate had just barely managed to pass its version of the "reform" act (visualize those uncertain quotation marks around every subsequent reference), and officially the House and Senate are now conferring over how to reconcile their two versions of the proposed law. This week, the Democratic leadership announced there would be no formal "conference committee"; instead, in a process known informally as "ping-ponging" and designed to avoid procedural delays, the leadership would meet with interested parties on both sides to draft a bill that would then receive up-or-down votes in both houses. The process will still likely take a while, as there remain significant and potentially unresolvable differences in the two adopted versions.

Doggett was among 60 House Dem­o­crats who wrote to Speaker Nancy Pelosi in July: "Any bill that does not provide, at a minimum, for a public option with reimbursement rates based on Medicare rates – not negotiated rates – is unacceptable." After intransigent Senate opposition, the surviving remnants of a "public option" are "health care exchanges" – insurance cooperatives that would in theory allow consumers some independence from the big monopolies – of uncertain utility and subject to "opt out" provisions from state to state. As Doggett points out – given the state record of doing only the absolute minimum on the Children's Health Insurance and Medicaid programs – we would expect Texas to choose "a substandard, second-rate system" with a diminished risk pool and no national negotiating strength, likely delivering "second-rate coverage at top-tier prices."

Bipartisan at All Costs

Doggett has additional objections to the substances of the bills, including the notorious attempts to add further restrictions on reproductive rights (Planned Parenthood opposes both bills in their current forms) as well as mechanisms (worse in the Senate bill) to pay for reform by taxing or limiting insurance coverages for large groups of middle-class consumers (the so-called "Cadillac" policyholders). "Taxing Goldman Sachs is one thing," Doggett said, "but it doesn't make sense to add to the burdens of ordinary folks who might now have good plans ... especially if you're being mandated to pay for an inferior product that you can't afford." He says progressive Democrats must insist on better affordability for the whole package.

Beyond these substantive disputes to be hashed out in the coming weeks, the congressman is greatly disappointed that the Democratic leadership, especially in the Senate, decided that it must have a filibuster-proof 60-vote majority to move the bill. He points out that both the Reagan and Bush tax cuts were pushed through a GOP-controlled Senate by simple majority votes – via the process known as "reconciliation" – and that in failing to use those tools, the Senate leadership made the legislation subject to "the tyranny of the least committed Senator." Hence the last-minute, demeaning negotiations with Connecticut Sen. Joe Lieber­man, Nebraska Sen. Ben Nelson, and others.

"It did not have to be that way," Doggett said. "When we passed the budget last spring, we provided for reconciliation. ... But there was such an incredible desire to get a bipartisan bill, even if it meant a weak bill. Instead we have no bipartisanship – given the unyielding opposition of the Republicans – and we have a weaker bill than we should have had."

Keeping On

Doggett had similar if milder criticisms of President Barack Obama – "there have been times when there's been more interest in bipartisanship than best policy" – and says that the Democrats must begin to acknowledge the actual political situation instead of wishing for a better one. "I do think a considerable time was wasted trying to bring on board people who were never going to come on board," he said. "It's clear the Republican strategy is to do everything it takes to block action, and then to blame us for inaction."

Not too long ago, roughly 20 years – the sharp division is marked by the House GOP leadership under Newt Gingrich and Tom DeLay – despite major differences between the two parties, it was still possible to find some consensus and compromise on practical national problems like health care. In the increasingly poisoned and polarized political atmosphere, that no longer seems doable. Doggett said that in terms of those officials working for "a common purpose and a reasonable approach ... the only debate that's happening is within the Democratic caucus." He noted the steady flow of "hate e-mail" he now receives on these issues, along with another trend: "There's a smaller stream of incoming comments – 'I'm ready to drop out,' 'only a third party can solve this,' 'nothing can be done.' I understand that impulse," he said, "but yielding that ground is the wrong response. ... We need those very people who are talking about dropping out to increase their engagement, rather than to stop engaging."

As he works to decide what to argue and how to vote on the final legislation, Doggett reached out to those who still want real reform, for solidarity and continuing activism. "All I know to do is to keep engaging and to try to learn from the strategic errors that others have made, and try to vocally demand a different strategy," he said. "I am trying to be candid and realistic – but also to do something, in Jesse Jackson fashion, to keep hope alive."