Threading an impossible needle

THREADING AN IMPOSSIBLE NEEDLE…. It’s probably an esoteric point, but it’s worth pausing to appreciate just how ridiculously challenging it was to craft this health care reform proposal. There’s a very good reason this legislation has never passed up until now, and why presidents who’ve tried have failed, and it goes beyond just right-wing hysterics and corporate pushback.

Think about the scope of the task — Democrats were told they needed a health care reform bill that spends a lot of money on covering the uninsured, lowers the deficit, strengthens Medicare, helps businesses, eases government budgets, protects consumers, and controls costs, all at the same time. It would also need to earn the blessing of Congressional Budget Office, the American Medical Association, the AARP, and the nation’s largest labor unions.

Democrats were also told they needed to do all of this in the face of unanimous and apoplectic Republican opposition, far-right manipulation of gullible conservative activists, and media coverage that largely ignores the substance of the bill while pretending every right-wing attack deserves attention.

This is a needle that’s almost impossible to thread. And yet, that’s exactly what the White House and congressional leaders have done. It’s no small feat.

But it might yet fail anyway, in part because some Dems prefer cowardice to success. Ezra Klein does a nice job setting up the substantive dilemma facing Democratic lawmakers who are thinking about siding with far-right Republicans to kill the legislation.

If you’re a liberal House Democrat, here’s what you’d be voting against: Legislation that covers 32 million people. A world in which 95 percent of all non-elderly, legal residents have health-care coverage. An end to insurers rescinding coverage for the sick, or discriminating based on preexisting conditions, or spending 30 cents of each premium dollar on things that aren’t medical care. Exchanges where insurers who want to jack up premiums will have to publicly explain their reason, where regulators will be able to toss them out based on bad behavior, and where consumers will be able to publicly rate them. Hundreds of billions of dollars in subsidies to help lower-income Americans afford health-care insurance. The final closure of the Medicare Prescription Drug Benefit’s “doughnut hole.”

If you’re a conservative House Democrat, then probably you support many of those policies, too. But you also get the single most ambitious effort the government has ever made to control costs in the health-care sector.

Greg Sargent added, “The House Dem leadership’s game plan all along has been to tell wavering conservative Democrats who voted No last time that they have now gotten their way — a bill with no public option, a bill with stronger cost controls, a bill that’s more fiscally responsible, etc.”

In a divided Democratic caucus, featuring liberals and conservative Blue Dogs, the trick was to find a way to deliver on what both contingents wanted to see in a reform bill. As impossible as this seemed, the final Democratic reform proposal does just that.

I have no idea what’s going to happen when the final roll call is held, but Democrats have no reason, no excuse, no coherent rationale for killing the best chance the United States has ever had to pass health care reform.