A Vote for Health Care Reform (New Eng Jour Med)

[pinto]

Author makes this case - "This bill will lay the foundation for a fairer, more efficient health care system and move the United States closer to universal coverage. This is health care reform worth voting for." ~ pinto

A Vote for Health Care Reform

NEJM
March 17th, 2010
Jonathan Oberlander, Ph.D.

Health care reform legislation has languished in political purgatory for the past 2 months, teetering between historic enactment and epic collapse. The House of Representatives and the Senate both passed health care legislation at the end of 2009. After a year of tumultuous debate, agreement seemed near on a final compromise bill that would represent both a substantial advance in health care coverage and a major political triumph for the Obama administration.

But the stunning victory of Republican Scott Brown in Massachusetts’ special Senate election in January sent health care reform into a tailspin. Democrats lost their 60-vote, filibuster-proof Senate majority and, briefly, their appetite for taking the final, difficult steps to enact health care legislation. Worries surfaced that the Massachusetts results signaled an erosion of public support for reform and an intensifying political backlash that could lead to significant losses for Democrats in the 2010 Congressional elections. Amazingly, health care reform legislation that had already passed Congress suddenly appeared in jeopardy of unraveling, as attention turned to the merits of more incremental reforms.

Yet as the health care reform debate enters its final act, Democrats have regained their political nerve. In the House, Speaker Nancy Pelosi (D-CA) has been a persistent advocate of comprehensive reform that would substantially extend insurance coverage and regulate the insurance industry. In the Senate, support among Democrats for using the budget-reconciliation process — in which a simple majority of 51 senators is required to pass legislation — has grown as the prospects for bipartisanship have faded. The Obama administration has also recommitted to passing comprehensive legislation, with the President making a strong final push to persuade wavering lawmakers and a weary public that reform cannot wait. The President, capitalizing on recent news stories highlighting staggering increases in health insurance premiums for some customers, is focusing his closing argument on the need to curb insurance-industry excesses.

Thus, the political outlook for health care reform is improving, and Democrats are now close to securing enough votes to approve the legislation. Still, there is nothing simple about assembling a majority in the House to pass the reform bill approved by the Senate and also having both the House and the Senate pass a second bill through the reconciliation process to fix provisions in the original Senate legislation (Obama has proposed a package of such revisions, including elimination of the now-infamous provision giving Nebraska extra funding for Medicaid). Democrats have to grapple with procedural issues, including whether the House will alternatively vote on a package of reconciliation fixes without first directly voting for the Senate bill. After a year of worrying about securing 60 votes in the Senate to overcome a filibuster, the challenge is now greater in the House, where Pelosi must find a way to win over “pro-life” Democrats who oppose provisions in the Senate-approved bill on federal funding for abortion services that are less restrictive than those in the House-passed bill. Pelosi must also persuade nervous House Democrats that their Senate colleagues will follow through on promised changes if the House passes the Senate bill.

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http://healthcarereform.nejm.org/?p=3176&query=TOC

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