The immediate goal of Sen. Majority Leader Harry Reid is to satisfy the concerns of Sen. Ben Nelson of Nebraska, a staunch opponent of abortion rights who represents the 60th vote needed to cut off debate and bring the bill to a vote. But in the background, a host of other issues are in play. The unions, unhappy about the demise of the public option, are plotting their strategy regarding the bill's tax on so-called Cadillac health plans. Four senators, including erstwhile bill opponent Joe Lieberman, are urging the Senate to strengthen the proposed Independent Medicare Advisory Board so that hospitals and physicians would be subject to its cost-cutting moves in the first 10 years after the bill's passage. And 31 House members from Maine and California wrote letters to House Speaker Nancy Pelosi and Sen. Reid protesting provisions that would let insurance companies sell policies across state lines under certain conditions.
Meanwhile, the White House fired back at former Democratic National Committee chairman Howard Dean, who has been making common cause with Republicans by demanding that the entire bill be scrapped. Though there's a widespread belief that some kind of reform will be adopted, the opposing interests are using every weapon they have to block it or change provisions that threaten them.
The biggest challenge to reform, however, comes from the public. After months of rumors, disinformation and outright lies about various parts of the legislation, a Wall Street Journal/NBC News poll showed that 44 percent of Americans would keep the current healthcare system, while only 41 percent favored the proposed healthcare overhaul. Public opinion, of course, is notoriously fickle; but, especially in more conservative states, some Congressmen and Senators may be reluctant to stick their necks out on reform.
In the New England Journal of Medicine, meanwhile, two experts who led Institute of Medicine (IOM) studies on the uninsured issue remind us what our world will look like if healthcare reform fails. Arthur L. Kellerman and Lawrence S. Lewin point out that employer-based coverage of nonelderly workers is declining, leaving more people to the mercies of the individual insurance market. There is little chance that that trend will be reversed, because of the rapidly increasing cost of insurance, they observe.
Government subsidies have enabled many of the 7 million people who have lost their jobs during the recession to buy COBRA coverage, but most will become uninsured after their COBRA eligibility expires. And while federal stimulus funds have temporarily enabled states to maintain Medicaid coverage at current levels, the experts point out, "many states will cut theirMedicaid programs as soon as the ARRA funding ends. The UrbanInstitute predicts that in the absence of reform, the costsof uncompensated care will double in 45 states over the next10 years, and the number of uninsured could grow by more than30 percent in 29 states."During the same period, without the kind of cost controls that the reform measure would initiate, Medicare will go broke, the authors note.
There's much more in the article about the toll that the lack of coverage takes in terms of more severe disease, premature mortality, and family bankruptcy. The point is that, whatever a portion of the public may think, the status quo is not an option. We must surmount our parochial self-interest and pass healthcare reform for the sake of our common future. If it's true, as Hillary Clinton said, that we're all in the same boat on climate change, that goes doubly for health care.