Back in the days of the Bush administration, when the Republicans controlled both houses of Congress and the White House, the Republican leadership grew frustrated that Senate Democrats had the temerity to use the filibuster block 4% of President Bush’s ideologically extremist judicial nominations. In response, then Senate Majority Leader Bill Frist (R-TN) proposed using what he dubbed the “nuclear option.” Under the so-called nuclear option, a motion could be carried with a simple majority that would end the long-standing practice of the Parliamentary maneuver known as the filibuster, at least in the case of judicial appointments.

In the end, Senate Democrats proved again that they were entirely free of either principles or scruples. Throughout the Bush years, Congressional Democrats caved to whatever the Republicans wanted, out of fear of being called “obstructionist.” They were so frightened of the threat of being called names that they allowed the Bush White House and the Republican Congress to do whatever they wanted. The Democrats failed to mount an effective opposition.

Fast forward to late 2009. The Republicans have assumed the “obstructionist” mantle and wear it with pride. Prominent Republicans including not just shout-down radio nut Rush Limbaugh but also Louisiana Governor Bobby Jindal and others have publicly stated that they want President Obama to fail in attaining any of his domestic priorities. The Republicans are doing their best to achieve this goal. They have been entirely uncompromising on the tiresomely long-running debate over the proposed health care reform legislation which, at the time of this writing, finally appears to have a chance of passing the Senate.

Unfortunately the bill that has emerged from the Senate bears little resemblance to the lofty goals of those who proposed it so long ago. A number of prominent progressives including Howard Dean have advocated for voting down this piece of legislation on the premise that as written it would do more harm than good. Due to the complexity of the issue I am presently fence-sitting myself, but I am inclined to agree with them in principle. The only good part of the legislation as it stands is the abolition of the pre-existing exclusion, whereby insurance companies refuse to sell coverage to individuals who they deem may actually require health care services. Ending the pre-existing exclusion is a commendable aim, but a better bill would have consisted of this single point and left the rest out. Without a government-backed public option, the rest of the bill as it presently stands amounts to a nearly trillion dollar subsidy for the private insurance industry. Serious questions remain as to whether federal subsidies for low-income families and individuals will be sufficient to cover the new mandate that everyone has to buy insurance. I reject the unfounded assertion that the so-called “insurance exchanges” would work as well as a public option to control costs. If the exchanges were as effective as a public option, they would not have been included in this bill either. Without a government-backed public option that is available to everyone, the present legislation is yet another mechanism to transfer money from the paychecks of struggling poor people into the pockets of wealthy corporations and the already rich people who run them.

We have reached this unfortunate state because of the filibuster. With the Republicans united in opposition, the Democrats were required to cave to whatever demands were made by conservative Democrats and independents, Senators who might be called DINOs: Democrats In Name Only. These are anti-choice, anti-public-option, anti-progressives who cynically campaigned on the Democratic ticket to ride the wave of anti-Bush public sentiment, not because they actually support progressive causes. In order to pass health care reform legislation, Congress was compelled to severely compromise the bill, inserting language that would make it more difficult for a woman to obtain an abortion, killing the public option, and omitting any clause that would prevent insurance companies from charging unaffordable rates to those who are no longer excluded by their pre-existing conditions. As a result, the bill will not end the wave of medical bankruptcies that have swept the nation and which have been the topic of much discussion in the media.

My conclusion is this: it is time to kill the filibuster. When they are the minority party, Democrats are too timid in their opposition to actually employ the filibuster, and Republicans get their way. Now that they have a majority in the Senate, the entire Democratic party is essentially being told what to do by a small number of Senators who threatened to withhold their support unless the bill were watered down, emasculated, stripped of meaningful reform, and fouled by anti-choice provisions. Even when progressives have the majority, conservatives still get their way. All this is because 60 votes are required to end a filibuster. Yet the filibuster is not a Constitutional provision. It is simply accepted practice, a long-standing tradition. Ending the filibuster would not require a Constitutional amendment. Ending the filibuster would only require a simple majority vote, and the backing of the Senate Majority Leader.

In principle, we are a country of majority rule. Majority rule is the fundamental basis of democracy. Judicial review has become a cornerstone of Constitutional democracy: that is to say, if the majority passes a law that impedes the rights of the minority, the courts can strike down that law. As it has been used in the past decades, the filibuster does not serve the purpose of protecting the rights of individuals; it protects the special interests of the wealthy. The filibuster is anti-democratic. The filibuster is not a part of the Constitution. The filibuster must go.

Death to the filibuster!

The first of these is affordable, portable insurance coverage for everyone, including those who are presently uninsured.

Then he mentions the broad goal of controlling costs and cutting systemic inefficiencies, and gives examples of ways in which such cost-cutting measures would impact other aspects of the system.

It is on his fourth point that President Obama’s editorial waxes the most eloquent with specific policy agendas for the legislation under discussion:

Our reform will prohibit insurance companies from denying coverage because of your medical history. Nor will they be allowed to drop your coverage if you get sick. They will not be able to water down your coverage when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime. And we will place a limit on how much you can be charged for out-of-pocket expenses. No one in America should go broke because they get sick. Most important, we will require insurance companies to cover routine checkups, preventive care and screening tests like mammograms and colonoscopies.

All of these are, as I say, admirable sentiments: goals which you would think our whole country could unite behind.

Yet as it turns out these goals are quite divisive.  Such a hoopla in the press and in the halls of Congress has rarely been heard; and the things some of the pundits are saying are just simply unbelievable, as in, “I can’t believe you actually said that!”  The wild accusations are beneath us here at the Principles blog, we have no time for them.  Heck I hardly have time to post at all, these days…

But I think it’s worth noting here that there is a certain taste of political vagueness to that first point mentioned in President Obama’s op-ed piece.  In presenting the tremendous goal of providing affordable health insurance to everyone (including all those who are presently uninsured, as well as the significant portion of the population whose head of household is presently unemployed) the President’s op-ed does not mention any specific mechanism for providing affordable health care to those who can’t afford it.

We’ve all heard some options tossed around lately.  Some say, make health insurance mandatory.  Some say, create a whole bunch of local health insurance co-ops that would somehow offer alternatives to the large national health insurance corporations.  But what the Senate so far has been unwilling to say, what the President is no longer saying as loudly because he wants to get some darn legislation passed already, is that the best way to control the cost of health insurance is to offer a government-backed alternative and truly give people a choice.

This is what I would like to hear from the President:

All those who want to pay more for less coverage, you go ahead and keep your current private insurance provider.  All those who want better coverage for less money, fill out this form to sign up for the government option, and then just keep going to your preferred physician or other care provider.

I discussed this issue explicitly in the book in section 5.2.2, Universal Health Care:

In current public debate, the opponents of public health care never fail to mention that there are sometimes waiting lists for certain health services in other countries with public health care systems. Never do they mention that trauma patients must already wait several hours for emergency care in many underserved American hospitals. Never do they mention that the economics of health care in America excludes millions from the system.

It is defeatist to say, “We should not try to improve our system because there are problems with someone else’s system.” That is not a positive, winning attitude. Instead we must acknowledge our own faults as well as those of our neighbors, learn from those mistakes, and move on to create a new system, perhaps the best one devised so far.

The insurance system is the problem: it costs too much, and it provides too little care to too few people. The single-payer system, where a portion of all tax revenues is paid into a health care fund which in turn covers the operating costs of the health care system as a whole, is part of the solution. Re-instating the ban on advertising prescription drugs, which was lifted in the 1990’s and which is strictly enforced in many other developed nations, would help to decrease pharmaceutical costs and unnecessary prescriptions.

…The idea of mandatory health insurance completely misses the point. Our health care system has been destroyed by the insurance industry. We cannot look to the insurance industry to fix the problems they have caused. Instead we must make a new system.

Health care, including preventative medicine, should be free of charge for all Americans.

As you see, the goal I outline in the book is a much broader, more aggressive goal than anything Congress is debating right now.  Since it is clear that my ideas will not be passed into law this year, I think offering a government-backed health insurance plan that competes with private insurers is the best alternative that I have heard.

If Congress does manage to pass a health insurance reform bill in 2009, the reforms they implement could possibly be a first step towards the creation of such a system as the one I describe: health care funded by tax revenues instead of user fees.  Or, if their new system works well enough for now, the reforms implemented this year might continue to work well enough for the next fifty years or more.  Alternatively, if the new legislation is widely seen as a total waste of money flop and a failure, then the Republicans will have a better shot at the White House in 2012.  The Republicans are doing their best to convince people of this already, before the legislation is even passed.  They would prefer no reform to any reform; and if reform is to be passed, they will pick at it and pick at it until only the most useless parts of it remain.  I fear that if a complete compromise bill is passed with two or three grudging Republican votes, it will end up simply providing a tax subsidy to the insurance and pharmaceutical industries without actually changing anything.

The Democrats must not let the party of George W. Bush follow up the twin disasters of Iraq and the economic depression with a third disaster by letting the health care system continue to ruin lives by forcing people into health care related bankruptcy even when they have insurance.  Reform is essential, and the broader and more lasting the reform, the better.

If the Democrats in the Senate cared what I said, I would tell them not to listen to all the lobbyists crawling all over the capital right now; because if the Democrats in the Senate can stand together long enough to get the public option through, the American people will certainly thank them by giving them a majority again in the next two or three election cycles at least.

I’m sure President Obama will continue to do his best to exhibit leadership on this issue.  I hope that he will recognize how essential a public option is to any real reform.