Bob Laszewski at the Health Policy and Marketplace Review has argued that the SCHIP vote does not bode well for health reform, because ranking Republican Senator Charles Grassley did not vote in committee for the bill. His case, which he has made before, is that health reform needs a broad, bipartisan supermajority to be successful.
It’s a worthy admonition, to think about how any health reform needs to be successful after passage–and having enough political investment in its success.
Maggie Mahar at HealthBeat pushes back, saying that health reform is do closely tied to core values that the debate is inevitably going to be partisan.
Both are right: health reformers need to be aggressive in their outreach to all constituencies–even those that have historically opposed reform–and work for support from both sides of their aisle. But they should be mindful to keep the traditional health reform base united–and not let anybody hold health reform hostage, giving anybody veto power over the effort.
The SCHIP debate was instructive: the votes indeed *have* been bipartisan, with a significant number of Republican votes in the House of Representatives, and in the Senate Finance Committee, with Republican Sen. Olympia Snowe voting in support.
Laszewski thinks Grassley didn’t support the new SCHIP bill because of the change getting rid of the five-year waiting period for legal immigrant children. Regardless of “the merits” of the change, such a move was “a mistake.” I’ll refrain from the many humanitarian, public health, and economic reasons to support this provision of a much larger bill. If the Democrats didn’t make this change, it would have meant defections from the Latino caucus, and maybe from representatives of states–like California–that already provide coverage to those kids and don’t understand the arbitrary exclusion.
An attempt to get a few Republican votes, by leaving that provision (and many children) behind, would have been much more damaging to health reform–by undercutting the policy goal to cover all children, to undermine good policy, and to start to fracture the natural base of health reform. That would be a “mistake.”
Our attempt at health reform in California illustrates the problem. We had a bipartisan health reform negotiated by our Republican Governor Arnold Schwarzenegger and our Democratic Speaker Fabian Nunez.
Schwarzenegger wanted his health reform to have support from Republican legislators, and so he waited for them to engage in negotiations, from January throught August. Schwarzenegger let Republican legislators–who have shown that they won’t raise taxes to fund basic services, much less an expansion of health care–play out the clock. By the time Schwarzenegger decided on a ballot strategy to go around the Republican leaders, there were left with only several weeks to meet the required deadlines.
Schwarzenegger also placed a premium on representing allies in the restaurant industry, even though they have been rabid opposed to previous efforts. On their behalf, he opposed efforts to ensure that the employer’s contribution to health coverage was shared down through the workforce. That omission did not gain additional business support, but it was significant in losing some potential labor support–support that could have made the difference in getting the bill through the Senate. Especially with opposition that ranged from BlueCross to the tobacco industry, the reform needed all the support it could get.
In the effort to pass health reform, the goal is to get enough support for passage: a majority, and sometimes more. We should actively work to get support from unusual suspects, and both sides of the aisle. But that outreach should be seen as part of the effort to get enough support for passage, not as an additional obstacle to passage.