History in the making: How the Democrats crafted a comprehensive and fiscally responsible health-care reform package

By Michael J.W. Stickings

Conservatives, as expected, are freaking out and going into full-out fearmongering mode over the details of Obamacare. Take this headline at The Weekly Standard, for example: "CBO: Obamacare Would Cost Over $2 Trillion." Apparently, the CBO analysis of Obamacare, the comprehensive health-care reform package that will soon be heading to a vote in the House, is so bad that "it's not likely to convince wavering House Democrats to jump to the Obamacare side of the fence." Yes, it's a disaster: "This legislation is a ticking time-bomb."

For the love of Glenn Beck, what the hell?

Well, first, reform is about extending coverage and making existing coverage better, and more broadly about fixing an unfair and unjust system, not just about cost. Obviously, though, it's going to cost something. If you want to do repairs to your house, you're going to have to shell out some dough. Nothing is free.

But the CBO analysis, which focuses on cost, is actually extremely positive. Here's Ezra Klein:

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. According to the Congressional Budget Office, the bill cuts deficits by $130 billion in the first 10 years, and up to $1.2 trillion in the second 10 years. The excise tax is now indexed to inflation, rather than inflation plus one percentage point, and the subsidies grow more slowly over time. So one of the strongest cost controls just got stronger, and the automatic spending growth slowed. And then there are all the other cost controls in the bill: The Medicare Commission, which makes entitlement reform much more possible. The programs to begin paying doctors and hospitals for care rather than volume. The competitive insurance market.

Got that? Costs are controlled and, in the long run, deficits will be significantly reduced. Plus, there are all the various elements of reform. Republicans may still hate it, but Obamacare has something for every Democrat. And there's no good reason, at this point, with so much hanging in the balance politically, why any Democrat should vote against it.

As for the cost, though, Jonathan Cohn acknowledges that "these projections are not a precise science" but stresses that the Democrats "constructed a bill that, even in the worst-case scenario, CBO thinks would not raise the defict. It's not an ironclad guarantee, but it's as close as you can come. And if that's not fiscal responsibility, I don't know what is."

Republicans, of course, are blinded by partisanship and ideological fervour, but their own record, from Reagan's massive military spending to Bush II's massive tax cuts and prescription-drug benefits plan, is hardly one of such fiscal responsibility. I and many others would have preferred a more genuinely transformative reform package, including a robust public option, but it is truly impressive that the Democrats have been able to settle on a bill, however flawed in terms of what it leaves out, that does so much and yet is so fiscally sound.

Steve Benen effectively sums up where we are and how we got here:

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.

It's an incredible feat, when you think about it.

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. 

We are quite possibly watching history in the making. It's time for Democrats to make it happen.