Seizing Defeat from the Jaws of Victory: Health Care by the Numbers

December 18, 2009

David Coates, political science professor at Wake Forest University and author of the forthcoming book, “Answering Back: Liberal Responses to Conservative Arguments,” shares his perspective on the current state of the healthcare reform bill. To interview Coates, email Carol Cirulli Lanham at or call 972-818-0895.

David Coates

It is crunch time for progressives and health care reform. Have we reached the moment, as Howard Dean now says we have,[1] that so much has been drained out of the Senate bill in attempts to appease conservative Democrats that what is left is not worth supporting?

Do we abandon the bill and either start over, or use the reconciliation process to force through the House’s more progressive alternative? The numbers aren’t there in the Senate for a bill containing either the public option or Medicare expansion. The numbers are said not to be there in the House for a bill that excludes them. We seem defeated by the numbers.

But are we? Let’s do some other numbers. Let’s count what we have and what we might lose.

In the current Senate bill we have:

l. An extension of coverage to an additional 31 million Americans, with sliding-scale subsidies for those making up to 400 percent of the poverty level.

2. The largest extension ever of Medicaid to low-income families, making it available to families with incomes up to 133 percent of the poverty level.

3. Tighter regulation of the health insurance industry, to proscribe some of its more egregious practices – not least exclusion because of existing pre-conditions.

4. State-run insurance exchanges in which those without employer-provided coverage can find affordable health care.

5. New rules to allow young adults to remain on their parents’ health care plan until age 27.

6. New federal dollars for wellness and prevention programs.

What we apparently don’t have is:

7.   A public option in those exchanges, to compete with private insurers.

8.   The extension of the right to purchase Medicare coverage to Americans aged 55-64.

9.   Taxation on the super-rich to finance the reforms.

10. The abolition of annual and lifetime benefit caps, and other key consumer protections.

The question is this. Are 1-6 to be jeopardized because 7-10 are missing? Would that be good politics?

The answer depends on two things. It depends on how valuable the version of 7 and 8 in the Senate bill is likely to be? And it depends on how securely 1-6 (and a potential 7a – the House version of the public option) can be guaranteed by turning away from this bill to run the House bill through the budget reconciliation procedure.

Answering those questions has less to do with health care than with politics – pure, naked politics. At crunch times like these, politics is like poker. You have to decide whether to hold or to fold.

Next blog entry: Holding or Folding.

[1] Howard Dean, “Health-care bill won’t bring real reform”, The Washington Post, December 17 2009


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