Democrats lost leverage early in health reform debate

Democrats pushing for a government-backed insurance option as part of their health reform strategy are finding out the hard way that, by taking single payer health care off the table early, they have little leverage now to force a strong public plan.

Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa) (WDCpix)
Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa) (WDCpix)

Unlike the Republicans, who adopted the strong conservative position of resisting almost every Democratic reform proposal from the start, Democratic leaders ruled out the liberal single-payer proposal early in the debate. Now in search of a centrist compromise, GOP leaders have plenty of room to maneuver, while Democrats are left facing proposals that either dilute the public option or eliminate it outright. Indeed, the Senate Finance Committee is expected on Tuesday to unveil long-awaited reform legislating promoting the creation of private health cooperatives, not a public plan.

For many health reform and patient advocates, the developments have been a disappointment. After gaining both the White House and large majorities in Congress this year, the Democrats have made comprehensive health reform their top domestic priority. On the campaign trail last year, then-Sen. Obama came out in enthusiastic support of a strong public insurance option to compete with private insurers as a way to control premium costs, which are skyrocketing. In Congress, Democratic leaders in both chambers also gave clear endorsements to the public option. Even conservative Democratic Sen. Max Baucus (D-Mont.), who chairs the Senate Finance panel, promoted such of plan in a November 2008 policy paper detailing his “vision for health care reform.”

Republicans have adamantly opposed such a plan. But they’ve also had the advantage of knowing for months that Democrats wouldn’t push for anything more liberal. In August of 2008, for example, Obama said that the best option for health reform might indeed be single payer — which would eliminate private insurers in favor of government-backed, Medicare-style insurance designed to provide universal coverage. But he also conceded that it would be too difficult to launch quickly.

“People don’t have time to wait,” he said.

In May, the White House’s top health official told lawmakers that single payer coverage “is not something that the president supports.”

In the House, Democratic leaders held just one hearing this year on single payer, almost as an afterthought. And Baucus, for his part, ignored single-payer supporters until June, when Sen. Bernie Sanders (I-Vt.), the only upper-chamber lawmaker to support single-payer health care, set up a meeting between advocates and the Finance chairman.

The message to Republicans was clear: Single-payer health care would be off the table from the start.

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