How to Think About the Health Care Bills

The latest news on the health care front is that the version of the bill the Senate Finance committee is working on will not include a public option or a requirement that employers provide insurance for their workers. Meanwhile, “Blue Dog” Democrats in the House are still fighting Energy and Commerce committee chairman Henry Waxman (D-Calif.) over that committee’s bill. There are a couple of ways to think about these conflicts.

Despite their intransigence, lawmakers who oppose the public option often represent districts that would benefit greatly from a public plan. Jacob Hacker, a Yale political science professor and public option expert, explains:

A public health plan will be particularly vital for Americans in the rural areas that many Blue Dogs represent. These areas feature both limited insurance competition and shockingly large numbers of residents without adequate coverage. By providing a backup plan that competes with private insurers, the public plan will broaden coverage and encourage private plans to reduce their premiums. Perhaps that’s why support for a public plan is virtually as high in generally conservative rural areas as it is nationwide, with 71 percent of voters expressing enthusiasm.

Matt Yglesias argues that the overrepresentation of rural areas in the Senate is a big part of the obstacle blocking real health care reform:

[I]t does strike me as worth noting that when you read a puff piece in The New York Times about the Gang of Six bipartisan dealmakers in the Senate that vast power is being wielded by people who, in a democratic system of government, would have almost no power. We’re talking, after all, about Max Baucus of Montana, Kent Conrad of North Dakota, Jeff Bingaman of New Mexico, Susan Collins of Maine, Mike Enzi of Wyoming, and Chuck Grassley of Iowa. Collectively those six states contain about 2.74 percent of the population… The largest metropolitan area contained in whole or in part within any of those six states is the Albuquerque MSA, population 846,000, the 59th largest in the United States—smaller than New Haven or Fresno or Richmond.

That’s not very representative. But Matt Taibbi thinks that blaming the “Gang of Six” is a cop-out:

Make no mistake, this has nothing to do with Max Baucus, Bill Nelson, or anyone else. If the Obama administration wanted to pass a real health care bill, they would do what George Bush and Tom DeLay did in the first six-odd years of this decade whenever they wanted to pass some nightmare piece of legislation (ie the Prescription Drug Bill or CAFTA): they would take the recalcitrant legislators blocking their path into a back room at the Capitol, and beat them with rubber hoses until they changed their minds.

The reason a real health-care bill is not going to get passed is simple: because nobody in Washington really wants it. There is insufficient political will to get it done.

Of course, Democrats haven’t shown Republican-style party loyalty in recent years, and there are some people in Washington who want a real health-care bill to pass. It’s a safe bet that Teddy Kennedy and Henry Waxman and Bernie Sanders are among them. But Taibbi may be broadly right—the Obama administration could try to push to pass a health care bill through the reconciliation process (avoiding the threat of a filibuster), and that bill would probably be better than one that gets Mike Enzi and Chuck Grassley and Olympia Snowe on board. For whatever reason, the White House is going to push for the worse, weakened bill first. That’s too bad.

But maybe that’s too harsh on the administration. Maybe the problem really is Max Baucus. He did write this, after all.

UPDATE: You could also just read this Hendrik Hertzberg piece, which explains everything.