If the vote were on whether the country needs to reform the health-care system the legislation would pass Congress 435-0 and 99-0, the latter presuming that Senator Al Franken of Minnesota is still not allowed to take his seat.
But there is a clear cleavage on health care: lawmakers who want broader and more economical medical coverage only if it is so conformed that it is very good for the health business, the insurance industry in particular, and the rest who want it merely for the 46 million people who are now uninsured and the tens of millions of others who are losing the struggle to keep their insurance and make it serve their needs.
It will be easy to tell them apart before Congress acts, by the end of summer if President Obama has his way. The lawmakers who want to help the people will favor a public insurance option for those who can't afford the premiums of the private companies or all their covenants, including pre-existing conditions. Those whose real constituency is the industry will oppose the government-sponsored option.
Is it too harsh and too simple to divide our servants that way, those who work for the people and those who primarily serve the private interests? The comparison may be a little overblown, but not when it comes to health care. The great orator from the Painted Desert, Sen. Henry Fountain Ashurst, described why he so often said one thing back home and voted another.
“When I have to choose between voting for the people or the special interests,” he said, “I always stick with the special interests. They remember. The people forget.”
On health care, you can count nearly all the Republicans to be with the insurers. They gave us the Medicare subsidies for the commercial carriers, and the party will oppose anything that smacks of competition for the industry.
So will a sizable number of Democrats, including the two Senator Nelsons, Ben of Nebraska and Bill of Florida, whose votes will be essential if the Senate must break a filibuster to take up the bill. Ben announced May 1 that a public health insurance plan was a deal breaker and he listed the principles that he would insist be in a health bill. They were the same elements outlined by the leading insurance lobbying group, America's Health Insurance Plans. A former insurance company CEO, Nelson has raised more than $2 million from insurance and health interests in his Senate campaigns. He has gotten more insurance dollars than any senator who did not run for president.
Arkansas's Democratic congressional delegation may play a pivotal role in this fight. The jury is out on Senators Mark Pryor and Blanche Lincoln, who count themselves generally in the conservative or moderate coalition but have said that health coverage must be universal. So too on the state's two Blue Dog Democrats, Mike Ross and Marion Berry. You know where Rep. Vic Snyder and John Boozman will be. Snyder has a 100 percent voting record on public health interests, Boozman at 10 percent owns one of the worst records in Congress.
Ross is chairman and Berry vice chairman of the health-care task force of the 52-member Blue Dog Coalition, a caucus of conservative Democrats who distinguish themselves by raising huge sums from corporate and trade PACs every two years. The Blue Dogs complained two weeks ago that they were not being consulted in the development of the health legislation.
The Blue Dogs seem to have had trouble getting all the team on the same page on the public insurance option. A faction first seemed to oppose the idea altogether. Then 20 of the Dogs, including Ross and Berry, signed a pledge with Health Care for America Now saying that government should play a central role in regulating and financing health coverage and that people should have a choice between private plans and a public plan that guaranteed affordable coverage. Then, last week, a slightly larger group, also including Ross and Berry, signed a statement saying that the public plan should not be guaranteed and should be available at some future time only if cost containment and adequate competition are never achieved by the insurance industry.
Ross, the congressman from South Arkansas, added provisos that would make public insurance useless. The Blue Dogs would not support government insurance unless it paid the same reimbursement rates to hospitals, doctors and other providers that the private carriers did instead of the lower rates paid by Medicare and Medicaid and the public plan had to rely completely on premiums and copays without a government subsidy of any kind.
President Obama wants to finance universal coverage partly by cost savings from levelizing Medicare reimbursements and squeezing extravagance out of the medical system. You don't get those savings without a public insurance option. The industry knows that. In the end, it argues, insurance companies could not compete with Medicare and Medicaid's low administrative costs and lack of profit consideration if the entire market were ever opened up to competition.