The centrist healthcare plan

Despite the current conventional wisdom, the Senate Democratic national
healthcare proposal, supported by a 60-39 party-line vote on Dec. 24,
2009, is essentially a centrist proposal that brilliantly combines
liberal and conservative means and ends.

One way to prove the Senate bill’s essential centrism is that both the right and left are attacking it.

{mosads}The right calls it “socialistic.” Conservative columnist Charles Krauthammer wrote just after the bill passed the Senate:

“This is the most significant increase in federal government power and reach in generations, much more than Medicare. This is really taking control of a sixth of the economy. It’s an amazing achievement of the left.”

Oh, really?

Then how come so many on the left of the Democratic Party, such as MoveOn.Org and former Democratic National Committee Chairman Howard Dean, criticize the Democratic Senate bill, without a public option, as a sell-out to Democratic Party moderates and to the insurance industry? How come the largely conservative American Medical Association, the pharmaceutical industry and the major national hospital associations support it — all of which opposed a similar proposal when President Bill Clinton offered it in 1994?

Then there is the opposition on the left. Outspoken liberals such as Howard Dean and liberal talk show hosts and bloggers say they prefer no bill at all to one that has no public option and is no reform at all.

But how come every single liberal Democratic senator supported it? If it’s too conservative and pro-private-insurance-company, then why did all the insurance companies, conservatives and congressional Republicans oppose it so vehemently?

The fact is, at least the Democratic Senate bill supported an all-private insurance system with no government-owned and -run “public option” — sounds conservative to me — but with reasonable regulation of the insurance companies — sounds liberal to me. Maybe that’s why both left and right are attacking it — and why it looks pretty centrist to me.

The brilliant conservative-liberal accommodation in both the Democratic Senate and House bills — the big deal that makes the Democratic bill a truly centrist solution — is the inclusion of both the “individual purchase mandate” and the “coverage mandate.” The two go hand in hand. Here’s why.

By mandating that everyone purchase insurance (or pay a penalty if they don’t), including healthy young people, insurance companies can afford to insure everyone, regardless of pre-existing condition or chronic disease. Otherwise, the young and healthy would self-select out of the system and not purchase health insurance at that stage of their lives, thus leaving the insurance companies only with the highest-cost, older, sicker population.

In other words, young and healthy people are mandated, in effect, to subsidize the old and the infirm; and then someday, when they are old and infirm (and it will happen!), they will be benefited by a new generation of young and healthy people mandated to subsidize them. And so on.

Sound familiar? It should. The same universal-participation mandate, especially on young people to pay for older people, was enacted more than 60 years ago via passage of the Social Security Act. And it was clearly constitutional — at the very least, under the Constitution’s Commerce Clause.

Yet the latest Quinnipiac poll, completed Dec. 20, has public opposition to “the Democratic healthcare plan” at 53 percent to 36 (CNN/Opinion Research, Rasmussen and NBC/Wall Street Journal are at 14-15 percent negative against the Democrats’ plan). It is obvious the White House and congressional Democratic leaders need to develop a more effective and simple message to explain the bill (I would argue, for the most part, the Senate version) — and quickly.
 

There is no better communicator in the nation, perhaps in the world, than our president. President Barack Obama and the Democratic leaders of Congress need to repeat every day the following three simple core messages about the Democratic plan, which I assume will make it out of conference:

1) The uninsured will now be able to afford insurance;

2) The insured will never have to worry about losing their insurance or not being able to have new insurance because of pre-existing conditions or age if they switch jobs; and

3) The deficit will be reduced by over $130 billion over 10 years and over $1 trillion over 20 years, according to the nonpartisan Congressional Budget Office.

{mosads}When the final conference bill reaches the floor of the Senate and House, I also hope there will be a vigorous debate between Democrats and Republicans on the facts, informing the American people as to the real choices, the real costs, the real benefits and the real risks of this legislation, including who pays and who receives, how much and why.

If that happens, then regardless of the outcome, we as a nation will be in a better position to make improvements to this new health insurance system in the future and to find new pathways for more effective and equitable changes, if necessary, in the years ahead.

We owe no less to ourselves and to future generations.

Davis, a Washington lawyer and former special counsel to President Clinton from 1996-’98, served as a member of President George W. Bush’s Privacy and Civil Liberties Oversight Board in 2005-’06. He is the author of Scandal: How ‘Gotcha’ Politics is Destroying America.