Where do we go from here with Health Care Reform?

I will have to admit that as certain as I think we need universal health care reform, it doesn’t look likely it will get done this time. The election of Republican U.S. Senator Brown from Massachusetts, who is opposed to universal health care reform, may be the “nail in the coffin.” This will make it even more difficult to overcome the cloture rule in the U.S. Senate which requires 60 votes rather than the simple majority which is what the U.S. Constitution intended for passage of bills.

The people I feel empathy for are those left uninsured because of pre-existing conditions, lose or change jobs, are dropped by their insurance companies, and/or denied medical procedures that their insurance company unilaterally decides to refuse. For those who are one serious illness away from being “buried” in medical bills they may never recover from financially and may even force them into medical-related bankruptcy. For small businesses and the self-employed who, having no bargaining power enjoyed by large government entities and large companies, cannot afford medical insurance costs with decent coverage. And for seniors, who might see life long savings and investments disappear in an attempt to pay medical bills. All of the above are likely to be forced to go without or run the risk of too limited coverage. Many will simply choose to forgo medical treatment well beyond the time when it is wise to seek it rather than go through the demeaning process of public assistance.

I would prefer to see the Democrats (since the Republicans have opted out of process) work their way through a compromise between the House and Senate bills doing away with all the “deal making” provisions that were offered as compromises to get the vote of a few Republicans and/or hesitant Democrats to get the bill passed. The Democrat leadership managed this bill poorly and this administration got caught up in the process resulting in bad bills. They need to take the good provisions of the bill (about 80 to90% of what’s there), and write a “clean and clear” one. It should contain at least a public option, universal coverage, and be deficit neutral or better. Then, take it to both the House and the Senate for a vote. If Republican and Independent Senators want to filibuster, call their bluff. Let them take responsibility for their actions with the American people. If in the end the bill fails, that’s fine.

Although risky, I don’t think doing this would be devastating to the Democratic Party. The American public knows why we need this legislation. If the bill fails, we should carefully track the medical costs, coverage, along with profits of insurance companies and others in the medical field who have spent millions to defeat this bill. If they continue to be unreasonable in their costs and coverage or get worse, make it clear to the American people that an honest effort to provide good, universal coverage at reasonable costs has been offered to correct this situation. Then, remind the electorate that if they will send to Washington both Democratic and Republican Congressmen who favor meaningful health care reform, the Administration and Congress will make another run at it.

I know that unemployment, stimulus bills, national security, the wars, financial regulation, rebuilding of infrastructure, restructuring of education, etc., are out there and need to be addressed. And, in dealing with these, we should adopt the attitude that the “big boys” have gotten their “gift horse”, and they can expect no more. In fact, they should pay back their loans and we should stop the prevalent practice of corporate welfare. Instead, the emphasis now should be dealing with the myriad of problems in a fiscally conservative fashion recognizing that it will still be expensive and will require increased tax revenues. But, we should never lose sight of the importance of medical care which represents 1/6th of our GNP. This is not a small issue we can ignore and it is one that potentially affects almost everyone. If the insurance companies and others in the medical field can’t get their house in order to give universal coverage at reasonable costs, it won’t take many election cycles before universal health care reform will be mandated. Maybe this time, we will be ready to insist on a true universal health care system somewhat similar to what every other advanced nation in the world provides their people.


It will take some political courage to approach it this way; but, in my opinion, the time has come for the electorate to step up to meet the challenge by holding their Congressmen’s “feet to the fire.” We can’t afford to continue business as usual allowing us to drift into a declining second class nation where we don’t even have the decency to provide our own people with adequate medical care when it could be structured to be a deficit neutral program or better.

Closed door proceedings in Congress

There is a big falderal over the closed door sessions to work out a compromise over the health care reform bill. Republicans and other pundits, including U.S. Representative Jerry Moran, are all over this with criticism of the process. Unfortunately, with some of deal-making done in drafting of the U.S. Senate version of the health reform bill, Democrats have given opponents ample reason for criticism. The Democratic Leadership has handled this legislation poorly. They have gotten too wrapped up in trying to write legislation that will satisfy everyone and get votes instead of just writing a good piece of needed legislation.

But, under normal circumstances, closed door sessions to work out the details in the legislative process is steeped in tradition and long standing rules. The Constitutional Convention which drafted the U.S. Constitution was conducted behind closed doors. Most if not all caucuses of both parties are conducted behind closed doors. Most committee meetings are behind closed doors. Plus, like everywhere else in life, a lot of decisions are made over a cup of coffee, a few drinks, or a meal someplace in private. Almost all strategy discussions in the executive branch are behind closed doors. Although most court proceedings are open to the public, detailed discussion of cases goes on behind closed doors and seldom is the electronic media allowed into the court room.

Yes we have televised legislative committee hearings and even televised coverage of the U.S. House of Representatives (since 1979) and U.S. Senate (since 1986). And this media coverage may very well have been a mistake that now no one has the courage to retract. The reason for closed door proceedings should be obvious. Put yourself in a Congressman’s position. Cameras and audio recordings change the dynamics of the process and usually not for the good. Suddenly, almost everyone begins posturing for the media – they are elected officials after all. With cameras rolling, little serious give and take discussion goes on. Anyone who has watched C-span coverage should know this.

In these media circus environments, Congressmen are not going to say what’s on their mind and certainly not “off the cuff.” They are not going to offer opinions and then change their minds or adjust their positions based on better arguments presented by others. They are not going to appear uninformed by asking questions for clarification and understanding. The truth of the matter is that in many cases they are uninformed and rely heavily on their staffs for position papers. If they are going into a public hearing or making a speech on the House or Senate floor, their comments and questions are carefully scripted with “talking points” that are consistent with their ideology and party positions. It isn’t that they are lazy, it’s just that there is too much information for them to be an expert on every detail of what is often complicated legislation. They simply can’t read, listen to, and/or comprehend all that comes across their desks. And, they know that if they make a misstatement of any kind or say something that can be perceived as stupid, inaccurate, or inconsistent with previous statements, it will be put in a media archive someplace to be brought out by their political enemies to hammer them in the news media and certainly at the next election.

I would suggest that that is the very reason that watching hours and hours of C-span coverage is a waste of time unless, you are well paid to do it, politics is an avocation, or you don’t have a life. This is what the media, as the “fourth branch of the government,” should be doing and then reporting in a fair, unbiased way. Whether they do this well is a matter that needs further discussion.

We have a republican system of government. We elect people to go to Washington to represent us to the best of their ability. We do encourage people to contact their elected leaders and freely express their opinion. Elections and offering our views is the democratic part of the process; but, the actual legislation process is done by Congressmen. If they do it poorly, we need to replace them – Democrats and/or Republicans – in the next election. The sad fact is, that we too often don’t and no amount of open door, C-span coverage is going to correct this.

Yes, much of what a Congressman, President, or Court Justice does should be behind closed doors. Human nature and our political process dictates this. This is how compromise, which is the heart of our governmental process, occurs. Criticism about closed doors to craft legislation only gains traction when the American electorate fails to understand how their own government works and public officials and pundits take advantage of this ignorance.