Point Austin: Yes, They Did

On Sunday, as the U.S. House was preparing to enact comprehensive health care reform, Austin Con­gressman Lloyd Doggett marked the historic occasion succinctly: "You can sum up our many pages with four words: 'You've got health care.'" It's a declaration that should have particular resonance in Texas, where a quarter of the residents – more than 6 million people, including roughly 1.4 million children – have no health insurance and rely instead on emergency rooms for whatever belated medicine they might receive. That didn't stop Attorney General Greg Abbott from announcing his intention to join a multistate lawsuit against health care reform as "unconstitutional" – more 10th Amendment demagoguery as wrong on the law as it is on principle. In contrast, the Texas AFL-CIO's Becky Moeller responded: "The U.S. becomes one of the last Western democracies to make health care a right and not a privilege, and even if Texas enters the reform era kicking and screaming, our state will benefit the most. That is cause for celebration."

As more than one progressive observer has pointed out, the celebration is not unlimited. In a phone conversation Monday, Doggett added his own qualifier: "You do have health care – you just don't have as much health care as I would like you to have, as soon as I would like you to have it." The bill's strengths are undeniable. Principally, more than 30 million previously uninsured people will now have access to health insurance, an immediate boon both to them and, not insignificantly, to the rest of us – the overall risk pool is dramatically broadened, with less reliance on more expensive, tax-supported emergency services. The new limits on insurers – no exclusions for pre-existing conditions, no automatic "rescissions" for expensive illnesses, no lifetime caps – and the closure of the Medicare prescription "doughnut hole" are benefits that are right on principle and broadly popular with a public much battered by misleading media coverage.

Nevertheless, the absence of a "public option" – i.e., a Medicare-style, single-payer program that would honestly compete with private plans – undermines the law's cost-control goals. The alternative intended to do that work – state-managed private "exchanges" – doesn't even come with a rate-review mechanism, Doggett noted, "so separate legislation must be initiated on that, most immediately. The question is, as long as the Senate rules are the Senate rules, can you get that passed over there or can you get the anti-trust exemption removed, when [Nebraska Sen.] Ben Nelson wants to keep it?"

The People? Maybe.

The Senate, of course, is where good bills go to die, and where the "reconciliation" bill lingers this week. Presumably, the Democratic majority will approve House changes, but that is the same bunch who swore they would pass the public option "if we didn't need 60 votes" – but couldn't muster 51 when the opportunity finally presented itself. Amidst all the conservative ranting about "what the people want," support for a public option continues to poll above 60% – just not in Congress. As Noam Chomsky wryly put it, "It didn't have 'political support,' just the support of the majority of the population – which apparently is not political support in our dysfunctional democracy."

Doggett pointed out that while he waited until Sunday to declare his vote – "I wanted to be sure that I was voting on what I was told I was voting on" – you could almost make a decision based on the demagogic arguments made against reform. "If in doubt," he said, "you would want to vote in favor of this bill, not even having read it, just based on its opponents." That propaganda will persist, of course, and it won't help that several of the bill's important provisions won't take effect for several years, while the opponents rail against phantom "tyranny" and "communism." But it's also worth noting that the recent polls running against the new law (already swinging this week) included a considerable percentage of people who called it too weak – those folks are not joining the Tea Partiers any time soon.

Looking Backward

The politics of the entire process were depressing, beginning with President Obama's initial Olympian diffidence and the GOP's reflexive obstructionism. ("When the choice was between a really strong bill and a bipartisan bill, [Obama] chose the bipartisan route," said Doggett. "What we've ended up with is a bill that's neither really strong nor bipartisan.") At the end, the most dismal spectacle was provided by Michigan Dem­o­crat­ic Congressman Bart Stupak's insistence that the entire plan be held hostage to his personal opposition to abortion, sanctimony finally exceeded by Texas Republican Randy Neuge­bauer denouncing Stupak as a "baby killer" – though he since claimed to have been talking about the bill itself. As The Nation's Katha Pollitt wrote, men like these were "willing to let millions suffer and 45,000 people die every year unless they got to deprive women of their reproductive rights."

Of course, if real health care reform takes effect and becomes truly universal, millions more women (especially teenagers) will get the preventive medical care and information they need, and both unplanned births and abortions will inevitably decline. Neugebauer's Texas might actually lower its long-scandalous teenage birth rate.

To prevent that from happening, Gov. Rick Perry and Abbott will do what they can to obstruct implementation, even while Texas remains the national poster child for the health care crisis. During the last Legislature, Perry personally blocked an expansion of the Children's Health Insurance Program, although it had been endorsed by the Republican state Senate. In a lengthy letter to Obama thanking him for the new law, El Paso Sen. Eliot Shapleigh wrote: "If 'starting over' is what Republicans still want, then I ask you to review the history of health care in Texas from George W. Bush to Rick Perry – because 'starting over' here means no action at all to address woefully inadequate health care access in the least insured state in the country. Please know that we will continue to support your efforts and, once the bill becomes law, to defeat any lawsuit by extreme elements in Texas who persist in fighting issues settled long ago in the Civil War."

Some people are just really slow learners.

Sen. Eliot Shapleigh's letter on health care reform to President Obama is posted here.