Health Care Reform and the Art of Partisan Politics

The last time the US Senate held a vote on Christmas eve, it was 1895. In that one, lawmakers said it was OK for former Confederate army soldiers to serve in the military. The vote was hailed as a milestone in the slow national reconciliation following the Civil War.

No one was talking about national reconciliation following last week’s Christmas Eve Senate vote on health care reform. A bill was passed with unanimous support by Democrats, against the wishes of 40 resolute, disdainful Republicans.

The vote—and the long, vitriolic “debate” that preceded it—obliterated any remaining vestiges of collegiality and bipartisanship in the chamber…not to mention turning off those who see the issue to be complex and worthy of careful thought.

After struggling for decades to implement modest, incremental improvements to the nation’s fractured health insurance system, the Dems decided this was their best chance to do it up right. They weren’t going blow it, no matter what. So they cobbled together 60 votes–securing the last one in a particularly tawdry cash deal with a Senator from Nebraska–and then hunkered down.

There were 3 votes last week. Each one went down exactly the same way. 100 elected officials had their heels dug in for a week on the biggest piece of social legislation since John Travolta’s bell bottoms were banned in Boston.

Republican Senator Olympia Snowe of Maine, a moderate who has crossed the aisle many times in the past on health care and other issues, told the New York Times she was “extremely disappointed” with the process.

Once Democrats closed ranks, she said, “there was zero opportunity to amend the bill or modify it. Democrats had no incentive to reach across the aisle.”

And when the deed was done, Senate Majority Leader Harry Reid actually chastised the GOP for deciding “to stand on the sidelines rather than participate in great and greatly needed social change.” This comment, in this particular context, is the moral equivalent of an end-zone celebration worthy of 15 yards for unsportsmanlike conduct.

Whatever, the spectacle represented a new nadir in the nation’s 3-decade spiral towards an utterly polarized political system. Before last week in fact, there had never been a completely partisan vote on a social issue of such magnitude, or on major legislation of any sort, according to several Congressional historians.

The health reform bill, should it become law, would be social policy change comparable in scope to the formation of Social Security in 1935 and Medicare in 1965. Those landmark bills had substantial bipartisan support in both chambers of Congress. In the case of Medicare for example, the Senate vote of 68 to 21 featured 13 Republicans and 55 Democrats in favor, and 7 Democrats and 14 Republicans in opposition.

Even the 2003 expansion of Medicare to include a prescription drug benefit was passed with modest Democratic support.

And there is little chance the partisan divide will end any time soon. The battle will continue right through the 2010 and even 2012 election cycles, as Democrats try to rally support for the bill and Republicans look for every possible chance to say “we told you so.”

Reid, for example, has begun describing the fiasco as a battle of good vs. evil, with private insurers cast as the bad guys. “I don’t see this as 60 Democrats versus 40 Republicans,” Reid said. “I see it as 60 leaders who stood up to insurance companies and stood up for working families all across America.”

Reid’s colleagues were quick to pile on. Ohio Senator Sherrod Brown said the privates were “just one step ahead of the sheriff,” and California Senator Dianne Feinstein said the industry “lacks a moral compass.”

That’ll cost ya’ another 15 yards, fellas.

Anyone care to bet how the vote will go down on financial regulation, climate change and immigration?

Glenn Laffel is the Senior Vice President of Clinical Affairs at Practice Fusion.

25 replies »

  1. The big question is, “Who won?” The clear answer is: The health insurance companies and the health fascists. The health insurance companies get tens of millions of involuntary new “customers,” and the health fascists get to jam their cult ideology down everyone’s throats, enforced by fines in both cases.

  2. “I don’t have a problem with people getting rich through honest enterprise.”
    Everything about Al Gores campaign has been dishonest, have you not heard of the Hockey Stick and manipulated weather stations? I would have no problem ifit was honest but it is far from it, he is getting rich from fraud and corruption.
    Please use the inteligence we all know you have, I never said climate change was lies, I said Al Gore’s claims where lies, you should be able to tell the difference between what I said and what you falsely claimed to try and dminish my argument. Why do you on the left kill so many straw men? Would an honest argument kill you…of course not but you would never win an argument then.
    The hockey stick was a lie, most of his movie was a lie. Most of the AGW data is a lie. There is climate change no one argues that, the question is what causes it. Science shows most of it is natural, your lies try to blame most of it on man, something you can’t support and thus you make up graphs and fudge weather station data.
    Socialism is a lessor degree of communism. When they left can’t get communism they settle for socialism, when they can’t get that liberalism.
    “but is there a prerequisite that a certain percentage of people must suffer in abject poverty in order for capitalism to work well?”
    Not at all but there is a prerequisite that everyone must contribute to society in order not to suffer in poverty. You seem to forget millions more suffer poverty under socialism/communism then capitalism.

  3. Nate, if Al Gore is amassing wealth based on something he thinks is right, that would be capitalism at its best and you should probably applaud him. I don’t have a problem with people getting rich through honest enterprise. Do you?
    Of course the problem is that you are referring to climate changes as lies. I’m not sure why folks of the right wing persuasion decided to ignore science on this one. Do you think it has something to do with the organized corporate activities I mentioned above?
    If we are all up in arms about saddling the next generations with national debt, maybe we should be a little bit concerned with leaving them with an inhabitable planet, in which case debts won’t matter much.
    BTW, socialism and communism are not interchangeable terms and socialism has many shades of pink.
    I am all for capitalism and free market, but is there a prerequisite that a certain percentage of people must suffer in abject poverty in order for capitalism to work well?
    Is the happiness of the moneyed aristocracy dependent on the existence of rabble?

  4. Gentlemen: I see I have stumbled upon a Blog of highly educated individuals. I am not going to even try and have an intellectual conversation with you, quite frankly because I don’t come from the same background. I am one of the common men.
    What I would like to share with you is what some of us think about how to handle the Health Care situation that the majority of the country has clearly stated they do not want.
    We are going to start by protesting a Representatives office in Rock Hill, SC and have started a nationwide pledge to support every political opponent he faces in the future if he votes for final passage of this bill. He is the first one we are going after. The House passed their bill by just two votes. While we are not in his district his vote will effect the rest of our lives and we feel that we owe it to him to effect the rest of his if he votes for what his local constituents, and a large majority of the country don’t want.
    If you are interested in signing the pledge please go to the following link.
    For more information visit us at http://www.wethepeoplenc.org and click on the DEFEAT OBAMACARE Link.
    Thank You for your time and excellent work you do as doctors, and others in the Medical and Healthcare Industry. At this point in time I do believe we have the best Healthcare in the World. I hope in 10 years I can say the same.

  5. Margalit what is your opinion of those that push climate control and immigration? I ofter hear you rail against the capitilists side but can’t recall you ever being appalled by the lies and corruption it fights. Al Gore is making himself a billionaire off AGW and it is built on complete lies. He is gladly destroying millions of jobs and harming this country for his personal profit, does that not bother you at all? If Al Gore is willing to go to the level he has to make himself rich what level of counter measures do you find acceptable to stop him? You seem to think capitilism should only be allowed to bring a stick while socialism/communism brings a gun.

  6. jd, the Barrons were a bunch of individuals who exploited a completely new situation where a nation was being forged, on an entire continent, at very short order. Yes, they were corrupt and ruthless and they managed to corrupt a government that just emerged from civil war and was equally clueless as to how to manage this experiment. Presidents were getting assassinated in office and I guess the entire nation was making the rules up as they were going along.
    In their defense though, while the Barrons were amassing fortunes, so was the country at large. The unbridled capitalism may have sped up the ascent of the US to its super power status by many decades.
    I think the main difference between now and then is that unlike the nineteen century, today’s businesses are organized together and their efforts to thwart the interest of the people is a beautifully coordinated international machine.
    If you look at the list of members of the US Chamber of Commerce and their political activities from preventing climate control to regulating immigration to the numerous PACs to electioneering for business and hundreds of other regressive items, with no apology, one must conclude that corruption is now respectably fused into every government process.
    It’s like the difference between the Mafia and a petty thief.
    I’m not sure that we can dislodge organized corruption with the same level of success as we had in removing the cowboy Barrons from power. And to add insult to injury, I don’t see today’s corporations creating the same solid tangible wealth for this nation as their predecessors. Just blowing bubbles…..

  7. This is not about helping the general public get better health care, this is about special interests and a political body that is so out of touch with the true dynamics to the problems of health care, this legislative action borders on plain evil to me. And, the commenters here show no better insight than what I read at political blog sites and discussions with a broad spectrum of people in my interactions as doctor, colleague, neighbor, and citizen.
    There is no true, invested representation going on in Washington, DC, people. Just a bunch of selfish, ignorant, greedy, and clueless politicians who basically represent selfish, ignorant, greedy, and clueless citizens who vote the same idiots back in office every 2 to 6 years. It is the silent majority of physicians I will continue to insult and harass into action to stand up and fight this garbage.
    You say and do nothing, you deserve the destruction of health care coming! And it will be terrible to witness and endure, for anyone who took the Hippocratic Oath seriously when finishing medical school and practicing on American soil.
    Per George Carlin, you are all diseased!!!

  8. Big Gov lobbies and the unions for starters. Forced unionization and mandatory participation in Gov plans.
    Just becuase the nation took a few steps down the road of socialism doesn’t mean we sit back while we take the path to full blown Socialism/Communism.
    The sooner we turn around and get back to what made us the greatest country the better off our grandchildren will be. We can’t undo all the damage the left has done but we owe it to the future to get started.

  9. Nate, you live in a socialist country. Unless you’re older than I think you are, you have lived in a socialist country your whole life. The mainstream public debate isn’t about whether we have egalitarian redistribution but how much and what forms. Likewise, the debate isn’t about whether government should provide a safety net and domestic programs, but what kind and how large.

  10. Margalit, I’m sorry but that is totally unpersuasive. What lobbies are uniting to oppress the people in a manner or degree beyond that to which Big Oil and the Robber Barons of the railroads didn’t 100 to 150 years ago?

  11. jd, the Gilded Age was what Madison would refer to as a “convulsion”. It was a time of great turmoil and it propelled this country from an agrarian, civil war thorn nation into a super power. Industrial revolutions are traumatic, but even during the worst times, American workers’ wages were double those in Europe and almost 40 million immigrants preferred this country to the “old country”.
    The most interesting phenomena was, in my opinion, the ability of the system to regenerate and fix itself. The Gilded Age was followed by Roosevelt and the Progressive era.
    What is frightening today is the peacefulness, the apathy of the polity and the slow systematic change in the political system, which is not accompanied by increasing greatness of this nation. Quite the opposite I’m afraid. I guess only time will tell.

  12. What Matt is suffering is his unability to force the rest of the country into his communist programs. We aren’t England, France, or Japan nor do we strive to be. Not sure why you liberals can’t accept this.
    We designed this country so it couldn’t be hijacked by people thinking like Matt. If CA or MA want a French healthcare system you could have one tomorrow. The problem is Matt doesn’t want to pay for it, he wants to force those that disagree to also pay into his failure to be.
    This is why Communist and Socialist oppress their people and build walls around them, the ideology doesn’t work when smart people are free to get up and move out. Thus liberals trying to nationalize healthcare instead of legislating it at the state level where it belongs.
    I don’t know if it is complacent ignorance from their poor federally funded education or outright politicial dishonesty but the 60 vote requirement is doing exactly what it was suppose to, protect the minority from the majority trying to enslave it.

  13. Margalit, I suggest you read about the history of America in the Gilded Age. Your take on the system working well for the average American until recently doesn’t hold up. Special interests didn’t need cell phones to corrupt the government, or merely influence it in their favor.

  14. Matt,
    It’s not the filibuster or the cloture that are not democratic and it’s not the constitutional system that is at fault either.
    Unlike Europe, in addition to the Constitution, this country was founded on a pure Capitalist theory, and until now, it was served well by it. When America’s corporations were doing well, America’s people were doing well. In a flat new world, this alignment of interest is not so clear anymore, but that’s a different story.
    If you haven’t already, please read Federalist #10. It is pretty amazing how Madison anticipated the problems we are facing today and which to some extent were always there. While his analysis is nothing short of visionary, his proposed solution is currently failing.
    Mr. Madison was of the opinion that the sheer magnitude of the Union, both geography and population, will make it impossible for various special interests to unite and oppress the people. His logic, which held rather well for almost two centuries, was finally defeated by the Internet, live TV, cell phones and airplanes.
    We need a new solution, but unfortunately, there are no Madisons amongst our politicians.
    And I agree that bi-partisanship would be a form of collusion by parties to defraud the people. Individual representatives voting their conscience and the particular interest of their constituents on a case by case basis, regardless of party lines, is what we should have, like John Quincy Adams who resigned from Senate rather than betray his principles. Those days are long gone….

  15. archon41, you haven’t really been paying attention. All of us on this site who want to expand coverage also believe we overutilize care in many places…primarily specialist care and testing/imaging. The goal is to use less of that stuff for everyone, which means we can bring more into the system without increasing capacity.
    The point you make has some validity for primary care, where we don’t have a surplus of practitioners now and there will be more demand placed on the system. Thus, there will be some scarcity until new primary care physicians are trained. But, even here, there is a lot of waste. Physicians bring people into the office for things there really isn’t any need for (like following up for someone taking a medication when it is working as expected and there are no bothersome side effects). I wish more docs would tell people they shouldn’t come in just because they have a cold/fever as well, but even in nations with universal health care that often doesn’t fly.
    Technologies that have the potential to be big helps when it comes to primary care capacity include (secure) email, e-visits (video or structured text), and remote monitoring. These things could be scaled up more quickly than adding 5% more primary care doctors, probably.

  16. I have been greatly impressed by the grand, Hegelian discourses, with their penetrating “insights” into the mechanics of the health care infrastructure and the relation of man to society, that regularly grace this site. It occurs to me to wonder, however, if there has not been a certain reluctance to acknowledge some things not easily denied, starting with the fact that there is only so much health care “out there.” I have heard no one claim that the quantity of medical care can rapidly be expanded. To belabor the obvious: you cannot bestow additional care on some without taking it from others. By “others” I do not mean the despised “elite”–I mean those who are presently well-insured. Why do you find it so distasteful to openly disclose to them the loss that, under your schemes, they will surely experience? Why hide behind such equivocations as “equal ‘access’ for all”? Why not march openly under the banner “Equal Health Care for All”
    Yes, yes, I understand that the “others” are to mean-spirited, too incapable of spiritual uplift, to follow your lead–hence the need for circumlocution, misdirection and equivocation. I understand perfectly.

  17. The “Terminator” actor who represents California is right.Kill this Bill! Imagine the criminal behavior of all parties to shaft the American People. The power Brokers of greed and Graft have to hide in their den of inequalty.
    Really, the only sides in politics is Governmental representation of Corporations against the masses. To be a Liberal,Con,libertarian or any where in between.Is just a means to fracture meaningful discourse.
    While we fight among ourselves,politicians are manuvering to play on your fears and values.You vote for them and the next four years,they Ignore You! For some, the memories are as short as what they had for breakfeast. The next election cycle,the politicians begin to listen to the voter.The voter is flattered and the politician ;ignores them once again.
    The Reason they get away with this is because We fear our Government.Unlike Europeans who’s Government Fear’s The masses.

  18. Glen, this is just trash. I thought that Practice Fusion was a knowledgeable, progressive company but to read this contorted logic puts your whole enterprise in question.
    The Republicans made a well documented political decision that they would block health care reform at any cost. They were given numerous opportunities to contribute to the bill and indeed, a lot of the ideas in the bill were ones that Republicans had supported.
    In the end, they want the Democrats to fail and they don’t care if they have to take the whole country down to do it. I can’t think of a single good thing they have done for the country in the past 15 years that they were in power in Congress. Good riddance… may they wanter in the wilderness for eternity.

  19. Glenn, this is piffle. The Republicans have zero interest in creating a solution to health reform because it’s a Democratic issue, and any improvements in social programs result in long term affiliations of those programs with Democrats. Obama, Reid, Baucus and the rest spent forever letting Republicans into the process (Gang of six et al). They were down on their knees begging Snowe to come over and got her in committee. And then when an arguably more conservative bill made it to the floor, she voted against it.
    Finally, the 60 vote cloture thing is an undemocractic rule in an undemocratic institution. Given the natural advantages corporations and the rich have over the rest of Americans, and the huge influence money has over the legislative process, your desire for bipartisanship can actually be interpreted as extreme bias.
    Which is why sensible countries have democratically elected governments that can actually enact sensible policies. Rather than our situation of electing governments which can only easily enact policies aiding the rich (see, Bush GW)
    And of course those countries are able to actually make sensible changes to their health care systems. Most have in the last 15 years–we havent. And we are suffering the consequences

  20. There are several inaccuracies and omissions here.
    First, the obstruction by the Republicans was a deliberate policy begun even before the start of the Obama administration. They have refused to allow a vote on dozens of posts in the administration. They have insisted on party-line votes time and again, and on the use of cloture votes with the threat of filibuster whenever they disagree.
    Don’t believe me that Republicans are engaged in unprecedented levels of obstructionism? Check out this table. Or this one.
    On healthcare in particular the decision of the leadership was to make sure nothing got passed on the Democrat’s watch if possible. They didn’t want to compromise and get a 40% Republican bill and 60% Democratic bill (their electoral shares). How do I know? Because that’s what this bill is! This is not a single payer bill, or a public option bill, or even a Medicare expansion bill. It is a private insurance and Medicaid expansion bill. And unlike the Medicare Part D expansion passed by a Republican Congress and signed by Bush, this one is not expected to expand the deficit. Part D didn’t have any new taxes to support the large expense, but so-called deficit hawks voted for it anyway…the same people now decrying this bill though it collects new taxes or reduces other spending for every new dollar it spends.
    Under these circumstances, it is not fair to say the Democrats became more partisan in equal measure to the Republicans. I also don’t think it is fair to write an article focusing on how they deserve 15 yard penalties while ignoring many opportunities to point to similar or worse Republican examples. Death Panels, anyone?
    A party line vote could not be avoided by the Democrats…at least, no one has shown me a plausible way to do it, excluding, possibly, by adding the single vote of Olympia Snowe. But I don’t know what Snowe wanted that they decided they couldn’t give. Do you?
    Finally, while it pains me to see insurance misrepresented and scapegoated, this “15 yard penalty” stuff sounds like resentment talking. A penalty is a punishment, so consciously or not you are calling for the Democrats to be punished for their trash-talk. The stance you seemingly take is that of the objective moral arbiter, but is that what’s going on? Or, did you choose your team, then Reid/Feinstein/Brown/etc. said mean things about it which you resent, and want to see them pay for?

  21. While GOP is certainly not blameless, this legislation is unique in its magnitude and cost as noted in the main post here. Indeed, many of the Dems who actually voted for this required closed-door deals to ‘remind’ them of their support of this bill. Most have admitted they haven’t even read the whole thing! The potential damaging effects the current blatant partisan behavior will have on our country is yet unknown.

  22. I see bipartisanship as an exercise in outreach, really. To that end, I suggest that our “progressive” representatives host a series of town hall meetings to educate the public on the wondrous benefits of Cap and Trade and Comprehensive Immigration Reform. This would, of course, give them a well deserved opportunity to bask in the adulation of a grateful nation for their efforts on HCR.

  23. You castigate the Democrats for moving this important legislation forward without bipartisan support. Do you really think they are the problem?
    One needs only to look at the recent Bush Administration era to find the same form of partisan politics used by the Republicans on virtually every major piece of legislation. Did you castigate them as well?
    I believe the problem runs much deeper. The question is how can a democracy function effectively if ideologues on either side adamantly refuse to compromise on important issues? It can’t.
    When I visit different parts of the country, I often am struck by the disparate interests and concerns of our people. How can I, living in rural Vermont, relate to the concerns Southwesterners have about illegal immigration? How can someone in the Southwest understand the concerns and needs of a New Yorker? How can a New Yorker understand and relate to the concerns of the Midwestern farmer? How can the farmer relate to the problems of urban dwellers? We really can’t but we must try. We’re all in the same boat and we can’t ignore a hole in someone else’s part of the boat.
    To me, the miracle of our democracy is that our elected representatives generally have forsaken their parochial interests and have worked to accommodate the needs of constituencies they do not represent.
    That’s clearly not what is happening today! Our elected representatives are voting as blocks strictly along party lines. While I think the Republicans are far more guilty of voting as an ideological block than the Democrats (I was a Republican but as a centrist I now regularly cross party lines), they both are, and have been, doing it — and all of us irrespective of our interests and beliefs, are the losers!
    How can any legislation get passed if the minority party says you must do it our way or we will vote as a block against your bill? That’s tyranny by the minority — and unless the other side closes ranks and also votes as a block, nothing will get done.
    So what’s the solution? We have to rediscover how to make our great democracy work. We have to drop today’s “after me you come first” mentality. We each have to accept legislation that accommodates and meets the broader needs of our entire body politic, not simply our own. And we must instruct our congressional representatives that they must compromise and vote to get things done even if their vote goes against the wishes of their party leaders.
    In short, we’ve got to recognize that we, indeed, are in the same boat and can’t try to force our positions on everyone else. When each of us again is open to — and accommodates — the needs of others, we again will be able to resolve both big problems like healthcare reform, and lesser issues, with bipartisan support.