Plan B

From JustOneMinute, quoting the Wall Street Journal (emphasis mine):

President Barack Obama will use a bipartisan summit Thursday to push for sweeping health-care legislation, but if that fails to generate enough support the White House has prepared the outlines of a more modest plan.

His leading alternate approach would provide health insurance to perhaps 15 million Americans, about half what the comprehensive bill would cover, according to two people familiar with the planning.

Half? I simply do not understand how we ended up in this position with a Democratic Congress and a Democratic President. Surely the priority for Democratic health care reform would be - should be - to make sure people who don’t have health insurance get health insurance. Sure they went off-track a little and instead of a ten-page bill that made sure people without health insurance could get health insurance, they ended up with a bill that has an additional 1,990 pages that do who knows what. Now they’ve realized they may not be able to pass their 2,000 page bill. So do they eliminate the 1,990 pages of dreck and keep the ten pages that actually get everyone health insurance? Of course not. They eliminate the coverage for half the uninsured and keep, well, I have no idea what they’re keeping.

I’m sorry to repeat myself but this just makes me nuts. If President Obama, Harry Reid, and Nancy Pelosi had any sense between the three of them then on January 21, 2009, they would have proposed a bill that made sure people without health insurance could buy it if they wanted to. Let everyone who wants to buy into the Federal Employees Health Benefits Plan or buy into Medicaid or buy whatever insurance they want and subsidize those who cannot afford to do so. That should have been their priority and it would have been politically feasible. Even all those people who are very happy with their existing health insurance worry about what would happen if they lost their jobs or their premiums skyrocketed. As for paying for it, they could have used some of the money that went into the stimulus bill. Heck, David Plouffe himself said that health care is a jobs creator.

Insuring the uninsured would have solved the most urgent of our health care problems and bought the country time to figure out how to lower health care costs. And since the Democrats would have successfully accomplished the task of protecting everyone’s health insurance they would have had political capital to help push through the rest of their health care reform.

Instead, Obama and the Democrats ceded not only the best political ground but also the best moral ground and committed themselves primarily to lowering health care costs. They acted as if extending coverage was a sort of dessert they'd promise not consider unless they managed the Brussel sprouts of cost control. That's a strange approach for Democrats and particularly Democrats in control of the Federal government.

Clive Crook believes that Obama’s closing statement at the health care summit:

did crystallise the key point of difference between the two sides. Democrats mainly want to expand coverage, and promise to contain costs in order to pay for it. Republicans have the opposite priorities: first contain costs, which they say would make insurance more affordable.

I don’t see it that clearly in the transcript but even if Crook is right, he goes on to acknowledge that:

Up to now [Obama] has emphasized cost control first, broader coverage second--because that is where most voters seem to be. Relatively little effort has been spent on making the case for wider coverage, and on persuading the country that this is worth paying for. Making the switch now comes a little late.

In other words, what could have been - should have been - a golden opportunity to accomplish what I always assumed was a key Democratic goal of insuring the uninsured has been frittered away. We’ve spent a year on a health care reform bill that probably won’t pass; we’ve spent a year with the uninsured staying uninsured; we’ve reduced the chance of any bill that covers the uninsured getting through Congress; we’ve done nothing to address health care costs; and while we were failing to accomplish all that we also weren’t paying much attention to stuff like improving the economy and getting people back to work. (Although if the health care reform process is any example, the economy and the unemployed might be better off if Congress and the Administration don’t try to help them.)

What the heck happened?