If Democrats enact something like the health-care bill emerging from the Senate Finance Committee, they may call it a legislative victory and it may keep the campaign donations flowing from the insurance industry, but the Democrats would surely infuriate millions of American voters.
Indeed, it seems like some Democrats, such as Sens. Max Baucus and Kent Conrad, have lost themselves so much in the inside-Washington reeds of legislating a convoluted compromise acceptable to the insurers, that they are inviting an angry backlash from average Americans.
The danger for Democrats is that this industry-friendly legislation would impose new burdens on citizens, including government fines for failing to sign up for a health-insurance plan, without guarantees that the coverage won't be almost as crappy and expensive as it is now. The bill rejects a public option that would put competitive pressure on private insurers.
Plus, key elements of the bill, like the so-called shopping "exchanges," aren't to take effect until 2013, meaning that Americans will have watched this messy process unfold for months and then be told that the current system, which has cruelly pushed millions of sick people into bankruptcy, will get four more years to bankrupt more Americans.
By contrast, Medicare, the single-payer health system for senior citizens, was signed into law on July 30, 1965, and took effect on July 1, 1966, less than a year later.
The Senate Finance Committee bill also is so complicated that few citizens can possibly understand it or how it might affect them. Instead of straightening out the health-insurance maze, the bill makes it trickier to navigate. [To see for yourself, click here.]
While dumping the relatively straightforward public option, which President Barack Obama favors and which is in the four other committee-approved health-care bills in Congress, the Finance Committee bill offers "non-profit, member-run" co-ops for individuals and "small group markets."
The co-op notion is a populist-sounding alternative favored by the insurance industry because a co-op's organizational difficulties and relatively small size would make it easy to compete against, much as small food co-ops can be overwhelmed by the pricing advantages that favor large grocery store chains.
The other glaring problem for co-ops is that most Americans, especially small-business people, are extremely busy already. They don't want to take part in running an insurance company; they simply want to get health insurance at a reasonable price.
Nor do most Americans want to puzzle their way through Baucus's hodge-podge of private insurers, government subsidies, emergency waivers, penalties for non-compliance, etc., etc. If Americans lose a job or fall on hard times, they don't want to go hat in hand to some government bureaucrat and have to lay out their financial problems to get some special favor.
What Americans Want
What Americans want is affordable health coverage provided in as simple a package as possible.
That was the finding of a New York Times/CBS News poll which discovered widespread confusion about the health proposals taking shape in Congress, but more than 2-1 support for a public option to compete with private insurers -- 65 percent for a public option, 26 percent against and 9 percent no opinion. [NYT, Sept. 25, 2009]
After all, one of the attractions of the public option is its relative simplicity and cost-effectiveness. It could piggyback on the existing Medicare bureaucracy and thus get started quickly and cheaply. According to congressional budget analysts, it is the only plan that offers significant cost savings.
Cost savings would not only help reduce the federal deficit but they would mean that more Americans would get the health care they need without going broke. In other words, it would save lives, reduce housing foreclosures, and protect families now being ripped apart by brutal financial pressures.
Yet, despite this common sense - and broad voter support for the public option - the Senate Finance Committee rejected the idea. Chairman Baucus conceded that the concept was appealing, but he joined other conservative Democrats in voting no, claiming a public option couldn't clear the 60-vote hurdle to stop a Republican filibuster.
So, instead of trying to rally the votes - or using the "reconciliation process" that allows a simple majority to enact legislation having budget implications - Baucus kept on cobbling together a nearly incomprehensible construct of tax credits, income formulas, fees and other mumbo-jumbo.
This modified Baucus bill is in line to win final committee approval this week. According to Washington's "conventional wisdom," it will then become the vehicle for action by the full Senate, where Democratic leaders have been ambivalent about a public option.
Some observers feel the best chance for the public option to survive may be with a trigger mechanism that would permit it in some parts of the country sometime in the future if private industry doesn't offer enough competition.
The trigger idea has been floated by Sen. Olympia Snowe of Maine, the only Republican on the Finance Committee who has indicated even a faint desire to vote for comprehensive health-care reform. However, the trigger would push even this limited public option to some point after 2013, when the insurance "exchanges" are finally scheduled to open.
Yet, if a trigger proposal is needed to win over some votes and beat a filibuster, another approach could be a "reverse trigger," one that would put the public option in place immediately but set up a trigger that would stop the public option from signing up new clients if private insurers cut rates by 25 percent and scored a 90 percent approval rating from customers.
Even then, the "reverse-trigger" public option would stay in place, serving the Americans who had already signed up and ready to resume taking clients if private insurers slide back into their old ways of excessive executive compensation, bloated bureaucracies and huge profits.
By moving up the timetable of reform to "as soon as possible" and putting immediate pressure on the insurance industry for real savings - in other words, letting voters see real benefits in 2010, not making them wait until 2013 - the Democrats could show they're on the side of the people and rack up electoral gains in 2010 and 2012.
However, if the Democrats insist on trading the common good for the favors of special interests, all the industry campaign donations in the world may not be enough to save them.