Here's an interesting wrinkle to healthcare reform that illuminates the difficulty of hammering out legislation with so many voices pulling lawmakers in different directions. It played out in the wee hours of the Senate Finance Committee's last markups to the healthcare bill submitted by Baucus last Friday morning. I'll let Ezra Klein set the stage:
But the drama came late in the evening. About one in the morning, Wyden's Free Choice Act came before the committee. But it never came up for a vote.
Instead, Max Baucus effectively ruled it out of order. The reason? It didn't have a full CBO score. This came as a surprise to Wyden and his team, who'd gotten the amendment scored by the CBO, and had been in endless negotiations with Baucus, the White House, employers, and labor over the past week. If the score was in fact partial, as Baucus and Conrad claimed, you'd think someone might have mentioned it. No one did.
But suddenly, in the wee hours of Friday morning, the chairs of the Finance and Budget Committees were explaining that the amendment lacked a valid score. ANde an amendment without a valid score is "out of order." Wyden was left with little choice but to withdraw the amendment. It was not deliberative democracy at its finest. But it served its purpose: it killed the amendment.
Klein does a great job of explaining Wyden's amendment and its importance to reform, but here I'll just say it would have given all Americans full access to the health insurance exchange, the place that allows consumers to buy a policy that falls under the restrictions of newly enacted community standards - no discrimination against preexisting conditions, etc - as well as the public option, when that's passed. If you work for a big company and you don't like your insurance, under Wyden's amendment you could ditch it and get something better.
With the amendment scratched, however, you're stuck with what you have. Reform will not touch you in any significant way.
For those of us who have been watching the legislative "process" unfold, that's not really much of a wrinkle, right? We've seen how Senators, time after time, cut down legislation that would open up the market to real competition, real choice, and access to effective and affordable insurance for fear of injuring the private insurance industry. Old hat, eh?
But the surprise in this particular amendment's demise is who opposed it:
The proposal was doomed by the joint opposition of businesses and labor. Businesses didn't like it because they lose control over their employees' health benefits. Labor groups didn't like it because they lose control over their members' health benefits. That's not an entirely selfish concern: It is easier to bargain on behalf of your workers or members if they have no other options, and thus are guaranteed customers for the insurer. But it is a short-sighted concern. It means the protection and preservation of a system where employers offer us one or two health-care choices, which may or may not be of high quality, and which will almost certainly dissolve if we leave or lose that job. It also means a system in which insurers compete less, and costs are further hidden from consumers, and businesses continue to bargain on their own.
One of the biggest mysteries to me swirling around healthcare reform is, where were the major corporations? Of all the stakeholders in healthcare reform, it's America's business community that stands to gain the most from good, comprehensive healthcare reform. (Okay, maybe the uninsured and the ill stand to gain more from an individual's point of view...) Under, say, a single-payer healthcare system, the burden for providing employee health benefits would - poof! - vanish. Sure, there'd be taxes to pay for the system that business would necessarily share, but it'd be no doubt considerably less than what they're dishing out now.
Of course, the present character of reform has removed them from the debate. Their beef isn't with the uninsured. It's with costs. They're there to shoot down anything that might steal from their bottom line - an employer mandate, say - but sitting quietly otherwise. And why not? For most of them, as with most of us, this bill will change the present healthcare status quo not one bit. Killing Wyden's amendments ensures that.
As for the unions, well they're looking out for their members. Period. A robust public option open to all reduces their bargaining power for their members.
It's frustrating to watch all this, isn't it? To get something good and comprehensive, like a single-payer system say, or a public option open to all, would require compromises from deep-pocketed groups to allow legislation to pass that would work against their interests. In short, they'd have to support something that's good for the country and its citizens, but bad for them in the short term, which takes courage.
I'm not saying it isn't possible. But under the conditions that this debate started - with a complex array of hodge-podge proposals and counter-proposals born out of the lukewarm pot of compromise with disparate and competing ideologies - there never was something to get excited, or courageous, about.
And thus died the Wyden amendment in the early morning hours in a Capitol Hill committee room late last week.