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Scott Brown’s Win and Healthcare Reform

Republican U.S. Senator-elect Scott Brown holds up a copy of the Boston Herald announcing his victory over Democrat Martha Coakley in Boston, Massachusetts January 19, 2010.   REUTERS/Adam Hunger   (UNITED STATES - Tags: POLITICS ELECTIONS)

Republican U.S. Senator-elect Scott Brown holds up a copy of the Boston Herald announcing his victory over Democrat Martha Coakley in Boston, Massachusetts January 19, 2010. REUTERS/Adam Hunger

There was talk over the last few days, from Nancy Pelosi and others, that the Democrats might use parliamentary tricks and outright chicanery to ram a healthcare bill through even if Scott Brown won in Massachusetts and take the party coalition down to 59.   Thankfully, cooler heads seem to have prevailed and that looks quite unlikely.

Virginia Senator Jim Webb made clear last night that he would not allow it.

In many ways the campaign in Massachusetts became a referendum not only on health care reform but also on the openness and integrity of our government process. It is vital that we restore the respect of the American people in our system of government and in our leaders. To that end, I believe it would only be fair and prudent that we suspend further votes on health care legislation until Senator-elect Brown is seated.

Indiana’s Evan Bayh has gone even further, warning of “catastrophe” for his party and adding “if you lose Massachusetts and that’s not a wake-up call, there’s no hope of waking up.” From what? Allowing its agenda to be set by its left fringe. “Whenever you have just the furthest left elements of the Dem party attempting to impose their will on the rest of the country — that’s not going to work too well.”

Other Democrats have joined in.  Rep. Barney Frank has issued a statement saying, “our respect for democratic procedures must rule out any effort to pass a health care bill as if the Massachusetts election had not happened.”  Former RNC Chair and current Pennsylvania Governor Ed Rendell said essentially the same thing in a Fox appearance this morning.  Granting that neither of them have a vote in the Senate, they’re very powerful indicators of sentiment in the Democratic Party.

Playing ping-pong or pretending that this is more budgetary policy would be suicidal for the Democrats and most of them know it, even if the senior leadership hasn’t caught on.

My guess, then, is that it’s back to the drawing board.

There’s an imperative to get something done about both coverage and costs.  The status quo isn’t sustainable, either economically or politically.  But it’s also rather clear that the majority of the country wants something less radical than the bills that have passed the House and Senate.

So, as Rendell also noted in his Fox interview, the Republicans aren’t going to get a free pass on this, either.  They’re going to actually have to participate in the process and propose alternative solutions that will address some of the very real problems in our healthcare system.   President Obama has offered some useful suggestions along those lines, such as allowing insurance companies to compete across state lines.   The GOP needs to seize on these rather than simply being obstructionist.

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About James Joyner
James Joyner is the publisher of Outside the Beltway, an associate professor of security studies at the Marine Corps Command and Staff College, and a nonresident senior fellow at the Atlantic Council. He's a former Army officer and Desert Storm vet. He earned a PhD in political science from The University of Alabama. Views expressed here are his own. Follow James on Twitter.

Comments

  1. Brett says:

    They’re going to actually have to participate in the process and propose alternative solutions that will address some of the very real problems in our healthcare system.

    Not unless they re-take control of the House and Senate. I mean, it’s not like they participated in the process when the Democrats didn’t yet have Al Franken’s seat, and since they just won on obstructionism, why upset the good vibe? Especially now that they can block any bill not forced through with reconciliation unless the Democratic Senate leadership somehow pull some Republicans away, and then crow about stopping “socialism” in the 2010 elections.

    Other Democrats have joined in. Rep. Barney Frank has issued a statement saying, “our respect for democratic procedures must rule out any effort to pass a health care bill as if the Massachusetts election had not happened.”

    Well, if it isn’t the return of my favorite Democratic past-time: the Circular Firing Squad!

    Playing ping-pong or pretending that this is more budgetary policy would be suicidal for the Democrats and most of them know it, even if the senior leadership hasn’t caught on.

    I’m not convinced. There was the same thing back in 1993-94, when you had the conservative Democrats welch on supporting Clinton’s bill because they were afraid of the political repercussions. Fat load of good it did them – they were, as they’ve usually been, branded with the rest of Democrats, and the first group to lose their seats in 1994.

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  2. DL says:

    A bit of unoticed irony is that this man who wore no clothes brings down the emperor who thinks his clothes are still on.

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  3. Robert Bell says:

    “Playing ping-pong or pretending that this is more budgetary policy would be suicidal for the Democrats and most of them know it, even if the senior leadership hasn’t caught on.”

    This kind of reasoning seems backwards to me now, and it seemed backwards when President Bush was in power. It seems to me that Democrats are being punished by their base for being too timid, and by Independents for not getting things done. Think of the attitude of Republicans and Independents on the non-event of Social Security Privatization.

    This is not a comment on the merits of their policies, just on the politics.

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  4. In that old internets phrase, “let me fix that for you” …

    There’s an imperative to get something done about both coverage and costs. The status quo isn’t sustainable, either economically or politically. But it’s also rather clear that the majority of the country wants something less [messed up] than the bills that have passed the House and Senate.

    I believe polls support something more radical than this bill (single payer), but the more radical was not acceptable to the medical-industrial complex.

    I get of course that the median OTB opinion differs from those national polls.

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  5. Rick DeMent says:

    he Democrats might use parliamentary tricks and outright chicanery to ram a healthcare bill through even if Scott Brown won in Massachusetts and take the party coalition down to 59.

    Yeah I guess getting only 59 out of 100 votes is “ramming it down” when it used to be called winning a vote in a democracy.

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  6. Mark says:

    To somewhat paraphrase something MY said, I can’t for the life of me understand why Democrats, with a large majority in the House, 59 votes in the Senate and control of the White House shouldn’t “ram a health care bill through.”

    Why should Democrats pay any attention to one election in MA? It’s not like Republicans paid any attention to the elections of ’06 and ’08. If you’re in power, you do what you can until you can’t. If you’re out of power you try to make it so the other side can’t. Pretty straightforward.

    Also, the House passing the Senate bill isn’t “playing ping pong”, it’s passing legislation as proscribed in the Constitution.

    If they can do it, they should do it. I’ll take the consequences of 2010, and so will the vast majority of the left…assuming we know our leadership actually has the balls to do what they think is right.

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  7. McGehee says:

    It’s pretty obvious Washington isn’t the only place where people need to learn some fundamental lessons the hard way. But that’s okay, there’s plenty of time, and still plenty of voter anger.

    A lesson learned too easily is forgotten even more easily.

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  8. yetanotherjohn says:

    I think this would be one of the smarter things the gop could do and one of the most dangerous.
    There are several potential areas. Insurance across state lines and portable insurance are two good examples. Tort reform is another good example, but that would make the dems howl. Allowing more foreign doctors would increase supply givers (and make the AMA howl). Faster drug approval and tiered approval could reduce cost.
    But the gop has to be careful to not get sucked in by the dems. Don’t start talking about tort reform and get a single payer system instead.
    The problem is that the broadest public support is for cost containment. The best government can do for reducing costs is to reduce regulation and government induced market distortions. But that works over time, not over night.
    For example, one of the demand side ways of reducing costs would be to make health insurance costs tax neutral. Right now companies get to deduct the cost of providing insurance and workers don’t have to pay taxes on the cost of the health insurance. So there is little consumer demand to reduce insurance cost because it is so well insulated. If you made the insurance cost a part of compensation and let people choose to take it in cash or coverage, you would likely start to see two things. More people would go without coverage and insurance costs would go down as more competition took place.

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  9. Franklin says:

    In that old internets phrase, “let me fix that for you” …

    Agreed that I didn’t see the healthcare bill as ‘radical’, in fact anything that has the major backing of the current healthcare purveyors is almost by definition NOT radical. And that was actually the problem with the bill. It was written by the biggest insurance and drug companies.

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  10. Dave Schuler says:

    There’s an imperative to get something done about both coverage and costs.

    I’m not certain what “imperative” means in this context. To the best of my knowledge the polls suggest that most Americans are concerned about healthcare cost and quality. Universal coverage, not so much.

    I’m not claiming that’s a strong moral stance. I think it could be argued that there’s a moral imperative for universal coverage. But I don’t see it as a political imperative except among a rather small portion of the electorate.

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  11. Zelsdorf Ragshaft III says:

    Get government out of the way and the price will go down. The market will dictate what sells and what does not sell. A one size fits all Government run program is not what I want and I surely do not think government has the authority to tell me I must buy a product or service. If you on the left want that sort of thing, migrate. America is populated by folks who wanted the freedom this nation offered. Most of your ancestors came here to escape government. Why on earth do you want to bring back what they ran from?

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  12. James Joyner says:

    I’m not certain what “imperative” means in this context. To the best of my knowledge the polls suggest that most Americans are concerned about healthcare cost and quality. Universal coverage, not so much.

    That’s likely right. They are concerned, though, about losing coverage when they’re too sick to work or when they change jobs.

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  13. Dave says:

    What components of the current legislation do you consider too radical?

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  14. Playing ping-pong or pretending that this is more budgetary policy would be suicidal for the Democrats and most of them know it, even if the senior leadership hasn’t caught on.

    I agree that the reconciliation route (i.e., treating it like a budget issue) would be problematic at this point.

    I will say this: I do not understand the notion that “ping pong” (e.g., navette, back-and-forth, or other names) is some kind of unusual or problematic process. It is a more transparent than a conference committee, and ultimately requires votes. Perhaps I am misreading the reference here, but have certainly seen it used as some sort of pejorative at Hot Air recently and elsewhere.

    And if they can get the votes, then I am not sure it if equates to political suicide, unless the argument is that any health care bill would be suicide–if so, the process isn’t really the issue.

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  15. Norman Rogers says:

    James, enough with the meme that the Republicans were being “obstructionists”. The Democrats made it clear that they’d ignore Republican input and drafted each of their bills (three in the Senate and several in the House) behind closed doors (Snowe did participate in some discussions in the Senate — but was allowed no substantive role).

    In the immortal words of the ONE, “I won.” Now he’s paying the price.

    Of course the Republicans have offered alternatives (tort reform, allowing insurance purchases across state lines, etc). These were all summarily rejected.

    If the Democrats want to pass a health care bill they can easily do so — by crafting a bill that enables consumers to purchase the coverage they want (one size does not fit all) and that eliminates the trial lawyers’ jackpots.

    Republicans would line up to support it.

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  16. steve says:

    “They’re going to actually have to participate in the process and propose alternative solutions that will address some of the very real problems in our healthcare system. ”

    I will be surprised if they participate. They seem set on making sure Obama does not get any bill through. There really is no leader on the right who has exhibited any real interest or leadership on health care issues. OTOH, there may be some room for financial reform efforts.

    Steve

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  17. Steve Plunk says:

    A hundred one percent solutions. Small bills focused on cost control will bring down costs/premiums and allow more people to be able to afford coverage.

    The folly of a giant health care bill is clear. Break this problem into smaller pieces and work through it.

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  18. M1EK says:

    “Of course the Republicans have offered alternatives (tort reform, allowing insurance purchases across state lines, etc). These were all summarily rejected.”

    Because these are completely useless on any of the metrics people are concerned about – they don’t help coverage and they don’t reduce costs. They’re feel-good rebuttals that don’t have any real policy impact at all.

    (We’ve had malpractice reform here in Texas; it did precisely nothing. Competing across state lines is irrelevant – state laws are too different to make this a win).

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  19. The problem with Republicans ;-), is that they don’t actually support the goal of universal coverage. They are holdouts for some sort of last-century social Darwinism. If you want good health, work hard. If you can’t work hard because you are sick … it must be your fault.

    The problem with Democrats is that they want more than basic universal coverage. They want equal coverage for the rich and poor. That’s going too far. Everyone should have a health care safety net, but there still needs to be a reason to work hard. That’s good and natural for the human spirit.

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  20. Wayne says:

    It is a bit hard for the Reps to participate when the Dems completely shut them out of the process.

    The Dems idea of a compromise is for the Reps to compromise and do what the Dems tell them.

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  21. Wayne, help me remember. Did the Republicans actually suggest anything supporting universal health care?

    In an extensive ABCNEWS/Washington Post poll, Americans by a 2-1 margin, 62-32 percent, prefer a universal health insurance program over the current employer-based system. That support, however, is conditional: It falls to fewer than four in 10 if it means a limited choice of doctors, or waiting lists for non-emergency treatments.

    Or were the Republican contributions just things acceptable to that 32%?

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  22. Wayne says:

    One more thing, why is it that even people like James is seems to always talk about what the Reps need to do? Why not talk about having the Dems not writing bills behind closed doors in the middle of the night and voting on them without even giving their members a chance to read it or their lack of reaching out to the Reps. They are the party in power. When will they be held responsible for their actions?

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  23. Wayne says:

    John
    The Reps are against Government run Universal Health Care. Mainly because they believe it will result in the second part of that poll. However they have put forth many ideas on how to improve health care.

    You prove my point though. Dems idea of compromise is that Reps must agree with them. I.E. you seem to be stating that if the Reps are against Universal Health Care then they have no ideas to and are against improving healthcare.

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  24. I’m actually chuckling here, as an independent (and still technically a Republican).

    Why on earth would a small minority in any democracy expect the majority to “listen to them” when it means abandoning majority intent?

    Geez, is this a definition of “compromise” sort like the Republican idea of “consensus?”

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  25. Norman Rogers says:

    M1EK writes, Because these are completely useless on any of the metrics people are concerned about – they don’t help coverage and they don’t reduce costs. They’re feel-good rebuttals that don’t have any real policy impact at all.

    (We’ve had malpractice reform here in Texas; it did precisely nothing. Competing across state lines is irrelevant – state laws are too different to make this a win).

    You don’t understand. In NY (and in most states), I can’t buy a “health insurance” policy that doesn’t cover pregnancy, psych, substance abuse, chiropractic care, etc. I neither need nor want to insure myself against the risk I’ll incur these expenses.

    The problems is there are too many “state laws”. I’d be in the market for a high deductible ($10,000) policy that cost me, say $100/mo. If I could get that from a carrier in AZ, I ought to be able to sign up. THAT’s insurance reform that would seriously reduce costs and would lead to vastly fewer “uninsured”

    OBTW, this is another of the great failings of the Democrat “reform” bill. It piles on even more “coverage mandates” — which are really just bennies to various special interest groups (like chiropractors, shrinks, etc.)

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  26. Gustopher says:

    Norman Rogers writes:

    You don’t understand. In NY (and in most states), I can’t buy a “health insurance” policy that doesn’t cover pregnancy, psych, substance abuse, chiropractic care, etc. I neither need nor want to insure myself against the risk I’ll incur these expenses.

    If you can guarantee that when you get pregnant, then go crazy because men shouldn’t get preganant, start taking drugs to try to make the shame go away, and then throw out your back because you’re not used to carrying that much weight around — if you can guarantee that when this happens you will not be using emergency rooms, or other government services, then you can opt out for coverage.

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  27. Our Paul says:

    Good grief James, there are those days when you are exactly like a dog chasing his tail. To wit:

    They are concerned, though, about losing coverage when they’re too sick to work or when they change jobs.

    That is exactly we we need Universal Health Care!!!

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  28. Wayne says:

    Re “Why on earth would a small minority in any democracy expect the majority to “listen to them” when it means abandoning majority intent?”

    Why on earth would a majority in any democracy expect the minority to “listen to them” when it means abandoning minority intent?

    Most don’t expect either. So there we have it. Now for those who actually want compromise, they would expect both side to listen to the other and find common ground or at least something acceptable to both sides.

    Isn’t that the definition of compromise?

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  29. Isn’t compromise needed, only really needed, when there isn’t a clear majority? That’s the way smaller players form coalitions, and gain the majority.

    Now say 40% wanted a Canadian system, 40% wanted a fully free market system, and 20% wanted a mixed solution public and private. Obviously then the two 40% blocks would try to form a coalition with the 20% and take control. The 20% would listen to the two sides. On the other hand, it’s unlikely the “Canadians” or “free marketers” would look for compromise with the far side.

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  30. Wayne says:

    John
    I’m not sure what you r point is. In your above example either one, two or all three groups would have to compromise.

    As for the current situation on health care, which are you saying need to compromise the Dems , the Reps, both or neither?

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  31. steve says:

    “The Reps are against Government run Universal Health Care. Mainly because they believe it will result in the second part of that poll. However they have put forth many ideas on how to improve health care.”

    As a physician I practice medicine. As a blogger I read and write on health care. Just exactly what are these “ideas” to which you refer. They give us magic pony platitudes, to steal a phrase, but no real plans. Beyond plans, name me some Republicans who have invested real political capital in promoting health care reform. All I see is efforts at opposition. I think I read all of the Republican proposals and saying that you love HSAs and free markets does not make for a proposal IMHO.

    Steve

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  32. Right Wayne, I’m saying the Dems don’t have to compromise. In a democracy, when you have a majority, you can just rule. To compromise at that point is (to put it rudely) charity.

    For a contrast, I didn’t like the Iraqi invasion, but I understood that a majority supported it, and the majority ruled. We do kind of wish we could do a “wait! you’re wrong” at a moment like that, but that is seldom possible.

    I certainly didn’t expect Bush to “compromise” with me and not invade.

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  33. BTW, as you might guess from that last post, I don’t think democracies are always right. Their only real strength is that they allow frequent change, without bloody revolution. Bush is out, Obama is in, nobody died.

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  34. Wayne says:

    John
    You are right. The Dems don’t have to compromise and neither do the Reps. Now they have a filibuster proof minority.

    The U.S. is not a pure Democracy but a Republic. Simply being in the majority does not give you absolute power. Not only do you need to get past the filibuster in the senate but you also need to stay within the U.S. Constitution as well as answering for your action in a election.

    Bush even when the Reps had control of congress did not get all he wanted because the Dems use of the filibuster rule and yes he had to compromise even with Iraq. IMO he compromise too much at times but that is another story.

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  35. Wayne says:

    Steve
    Here is some of the GOP plan
    http://www.gop.gov/solutions/healthcare

    You may think turning the U.S. healthcare into a socialist system is a way to go but many including myself don’t. If you truly practice medicine then you should know when the government gets involve it creates layer on top of layers of bureaucracy. There are even more layers you don’t see. Granted the Private insurance has their own bureaucracy but nowhere as bad as the government.

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  36. Norman Rogers says:

    Gustopher writes, If you can guarantee that when you get pregnant, then go crazy because men shouldn’t get pregnant, start taking drugs to try to make the shame go away, and then throw out your back because you’re not used to carrying that much weight around — if you can guarantee that when this happens you will not be using emergency rooms, or other government services, then you can opt out for coverage.

    Nearly all emergency services (including ambulances) are provided by private enterprises (both for profit and non-profit). And, they all expect to be paid when they provide services.

    I am well able to afford these services without insurance (catastrophic health expenses have little to do with emergency services — they’re occasioned long after one has exited the emergency room).

    And, I am content to bear the financial risk of pregnancy, mental health problems, etc., all by myself. Indeed, why should I not be permitted to self-insure against all medical risks?

    In any event, Obamacare is dead. Now we’ll see if the Democrats will yield on tort reform.

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  37. Anderson says:

    that the Democrats might use parliamentary tricks and outright chicanery to ram a healthcare bill through

    Oh, like the tricky chicanery of THE HOUSE PASSING THE BILL THAT THE SENATE PASSED?

    What, EXACTLY, would be tricky about that? Did the Senate not pass a bill? Does the House not have the option of passing the same and sending it to Obama?

    Can we take up a collection to send JJ one of those Schoolhouse Rock! DVD’s?

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  38. The filibuster rule is a strange evolution. I’m not sure it’s a good thing. Out here in California our budgets are busted in part because we have a “super majority” rule in the legislature.

    Maybe representative democracy would be better.

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  39. Yeah, what is chicanarous about both chambers of Congress passing a bill with identical text and having a President sign or veto it?

    That is what all bills that become laws eventually have to do.

    And James, go back to April when Obama was reported to have put tort reform on the table if that meant GOP votes and concessions… the GOP offered nothing back.

    And please remember the 3 months Baucus et al wasted with the Finance Committee mark-up where he was negoatiating with Snowe (a gettable GOP vote), Grassley (a reach, but plausible) and Enzi (no way in hell would he vote for a Democratic bill)and got jack-shit for it in terms in votes.

    The GOP made a strategic decision to say no and count on the public to go WTF — Dems have the White House and 60% majorities in both chambers and can’t get shit done, let’s go with the other assholes.

    And breaking a bill up into a no pre-exisiting condition mandate without mandates puts the US health care system into an adverse selection death spiral.

    Policy is complex and inter-related. All the basic parts need to be there, or it is a massive kludge; now is you want to quibble on details that is fine, but the moving parts are there for a reason.

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