Health care reform endangered by liberal circular firing squad

Howard Dean makes the pitch for public option health insurance at a May 27 meeting in Denver.
Howard Dean makes the pitch for public option health insurance at a May 27 meeting in Denver.

The risk of long-delayed health insurance reform collapsing under its own weight could come from an unlikely faction — the political Left.

That sinking reality was in full voice Wednesday at a Denver town hall forum featuring Howard Dean, the former Democratic National Committee chairman, ex-Vermont governor and a physician.

In his characteristically blunt political bedside manner, Dean rallied the crowd, “It’s not up to the right wing of the Republican Party, it’s not up to the health insurance companies, it’s not even up to Barack Obama … it’s up to you” to ensure Congress delivers patient-centric health insurance reform.

Whooping, hollering and a few crowd-pleasing political digs aside, Dean’s push for a universal “public option” that would allow people to buy into a government-run health care program, popularly known as Medicare for All, was met with cool skepticism by the left-leaning audience of 300 that clearly favored a single-payer plan and the abolition of private insurers.

But the political wisdom, such that it is in Washington, D.C., is that a single-payer plan is off the table according to U.S. Sen. Max Baucus, D-Mont., the chairman of the powerful Senate Finance Committee and a leader in health care reform on Capitol Hill. The single-payer showdown came to a head when Baucus had a disruptive group of five doctors and nurses ejected from a May 12 Senate hearing after they protested being excluded from the discussion.

Single-payer proponents were further left in the lurch when President Obama backed off campaign promises for a sole public health care financing program for the more moderate public option approach.

Dean dismissed concerns about the challenge of getting the steadfast single-payer faction to join a coalition with public option backers to fight the more entrenched insurance industry interests as congressional hearings advance toward the president’s August deadline for a health care reform package.

“The truth is there is no pure single-payer on the face of the Earth,” Dean told the Colorado Independent in an interview before the town hall. “Every system has a private insurance out.

“My attitude toward this is let’s get something. Let’s get the ball rolling. Let’s not have an argument between two poles. Let’s pick a middle course. Of course, the right wing and the insurance companies are already attacking the middle course. If there’s no public option we shouldn’t do anything. The last thing you want to do is pour a trillion dollars into something we already know doesn’t work right.”

Dean’s hard-won political skills from the Iowa caucuses to the smoke-filled rooms of the nation’s capitol may come in handy to head off another potential reform game-ender.

Domestic policy blogger Ezra Klein writes today at the Washington Post that liberal labor unions and policy groups may knee-cap reform efforts over a tax proposal backed by the Democrats. The Senate is expected to cap the employer tax exclusion — the estimated $300 billion annual tax break for firms that provide health care insurance to workers. Savings from the tax credit cap would be used to pay for the public option.

Capping the employer health care exclusion is good policy. Eliminating it entirely would be better policy. It’s true that some unions, like AFSCME, would see the value of their employer benefits degrade slightly. (Some unions, like Service Employees International Union, would scarcely be affected at all. Janitors are not, as a rule, given generous employer health benefits.) But the labor movement, as a whole, is much worse off in a world where the employer exclusion is capped but we have health reform than in a world where we don’t have health care reform and can’t control premium costs.

In that world, employers who offer health benefits will be ever less competitive against their stingier competitors. Union shops will close as the associated labor costs become unsustainable. Employers will fight ever harder against unionization because they’ll be terrified of being trapped into health coverage arrangements that they can’t control.

Concerns that industry lobbyists, unenlightened business groups and conservative ideologues will undermine, if not outright kill, health care reform may be supplanted by the Left’s own circular firing squad.

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