In what might have been the least suspenseful vote on a major issue in Congress for a very long time, the Senate tonight voted (60-39 on party lines, with my own Sen. Voinovich absent) to proceed to debate on healthcare reform. The Democratic caucus held together on the vote despite the various opinions on the bill in question within it. After Thanksgiving we will enter into what promises to be a lively exciting, and somewhat unpredictable debate and amendment process, but the circumstances of tonight's vote tells us something about where reform goes from here.
As a liberal, it really pains me to say this, but as a pragmatist I am forced to; the public option as we know it will not get through the Senate, if it does at all. The pressure on Joe Lieberman, who has promised to block ANY public option, may have been too great to overcome if he was the final holdout on it, but at this point he is not. Ben Nelson, Mary Landrieu, and Blanche Lincoln have all voiced their opposition to the public option in principle and will likely only settle for one in an extremely weak form (such as a trigger with realtively strict parameters).
In the words of many great mathematicians of the past, 56 is not 60. There is now a bloc of four moderate Democrats who will not stand for the public option opt-out. If they are not satisfied, healthcare reform will not pass. In order to save the substance of the core bill and remain faithful to the goal of not only having a great reform bill, but having one that actually gets to President Obama's desk, I think the Democrats should move on two fronts.
First of all, scrap the opt-out public option. Liberals will be furious, and I am disappointed that the opt-out doesn't have the votes. My disappointment and their fury, however, cannot change reality. Reality always scars perfection, but we cannot let the perfect become the enemy of the good. Amend the bill and go to a trigger option that will satisfy Nelson, Landrieu, Lincoln, and Snowe. With Senator Snowe's vote (the trigger is her brainchild, after all) Liberman could vote against any version of the option and the Democrats can still break the cloture threshold.
Step two, to compensate for the lack of the public option, and push for the kinds of regulations (like those in the House bill), that make the public option less important. I'm not familiar with exactly how many of these are in the Senate bill, but repealing insurers' antitrust exemption and making them justify price increases as utility providers do keeps a watch on price and immediately injects competition into the insurance market. Add to that guaranteed issue and rules against recission, and insurance companies are corralled when it comes to abusive practices. Add the loss of the antitrust exemption with pricing justifications and the new Exchange(s), and we have successfully harnessed market forces in a way that should push down prices dramatically. All this without a public option at all.
That is, I think, a winning formula. If you push the kinds of rules that vastly reduce the impact of the public option by achieving the same ends through different means, we can effectively diffuse the controversy around it. And if there is a weaker public option, that's just one more thing to help push down prices. That is a strong bill, it is a bill than can get to signature.
I know a lot of liberals who are compromise-averse will want to go to reconciliation or use the so-called "nuclear option," changing the filibuster rules. Neither will work. Reconciliation is limited to budgetary matters and is subject to the ruling of the Senate Parlaimentarian on the budget-relevance of the measures presented. Only a portion of the bill would get through, and we do NOT want to try to pass a comprehensive measure piecemeal and hand the Republicans an epic propaganda advantage to boot.
Changing the filibuster rules too, is a dangerous move. When the next George W. Bush tries to come in and mess with Social Security and Medicare (or maybe the results of our healthcare bill?) I want the rights of a Democratic minority preserved. Messing with the extensive Senatorial rights of the minority is very dangerous, and tilts our careful republican balance toward rash and possibly destructive action. We do not need two Houses of Representatives, much as I appreciate that House and Speaker Pelosi.
Liberals everywhere can be proud of tonight. we got a healthcare bill through the House and now officially to the Senate floor. We can smell victory. As with the House, however, the last and most important step in the process is compromise to broaden appeal and guarantee passage. We cannot hesitate. A good bill is better than no bill. And the vast good that will be done by the parts of the bill that can pass will outweigh our disappointment at having had to sacrifice our ideal.