President Obama has been very skillfully navigating the tricky waters of healthcare reform to this point. He has allowed Congress to take the ball thus far, and even though everyone keeps talking about Obama's Health Reform Plan, it is important to note that the President has not proposed a plan yet! Notice the difference between the way that this administration and the Clinton administration have approached reform - President Obama is allowing Congress to make all the initial mistakes, and he will come riding in after the dust settles to save the day. As Paul Krugman pointed out back in February there are big differences in Obama's approach to reform and Clinton's, and most of these are due to political realities.
There are now various plans, at various stages in both the House and the Senate, of which various aspects of each are being vigorously debated. The only plan that appears able to actually pass is still being worked out in the Senate Finance Committee by the so-called Gang of Six (three Democrats and three Republicans). These six hold the key to the President's plans for reform. They are:
Chairman Max Baucus (D-MT) has repeatedly stated that he will work on a bipartisan compromise. He agreed to keep negotiating with the rest of the gang through September despite pressure from the White House to vote on a health reform measure before the August recess. In the Great Falls Tribune, Baucus said "There's no bill yet because I haven't written it. There's just a lot of ... stuff out there. Health reform is not dead or dying; there's just a lot of misinformation out there." Baucus says he is committed to eliminating the current pay-per-procedure system and replacing it with one focused on quality outcomes. He has put healthcare cooperatives and a national insurance pool at the top of the list of reforms for health insurance.
Chuck Grassley (R-IA), a 28-year Senate veteran, faces a possible primary challenge in next year's election so he is being very careful. At a town hall meeting, a constituent told Grassley that if he helped get this bill passed he would lose the election. Grassley seems to have a real desire to reform healthcare, and has offered preliminary support for the health care co-op idea advanced by Kent Conrad (D-ND). Grassley has said, "Not all Democrats think the same and there's some that are like me, who do not want any more government interference in health care." If Grassley leaves the Gang, there is a big hole in the wall for any bipartisan compromise.
Kent Conrad (D-ND) is responsible for the healthcare cooperatives idea, which is now seen as the only path to a bipartisan compromise. Under the Conrad plan, cooperatives would be national in scope, and would receive startup money from the federal government. In the Wall Street Journal he said, "It is the only plan that has bipartisan support in the Senate." He also claimed, "It's quite clear the public option does not have the votes." Conrad was elected with 69% of the vote in 2006, but has recently been accused of receiving favorable terms on a loan on his second home issued by Countrywide Financial (since absorbed by Bank of America during the financial meltdown).
Olympia Snowe (R-ME) has been involved with healthcare issues since she was first elected in 1994. During the run-up to the health care reform debate, Snowe sponsored (along with Democrat Dick Durbin of Illinois) a bill establishing the Small Business Health Options Program (SHOP), which would enable small companies and the self employed to form state or nationwide health insurance purchasing pools. She holds one of the safest seats in the country, having won 74% of the vote in 2006, and is widely viewed as a moderate Republican.
Jeff Bingaman (D-NM), was elected to his seventh term in a 2006 landslide. Like Conrad, Bingaman is from a more conservative and rural western state. He opposes the public insurance option proposed by the House. He has been open to the idea of health care cooperatives as a way to help the uninsured. According to Politico, Bingaman favors a series of "benchmarks" to gauge the success of the health plan as it unfolds. Bingaman says, "I think that makes sense. You could make an evaluation and midcourse corrections if needed. I think that's the prudent thing to do."
Mike Enzi (R-WY) is the most conservative member of the Gang. The New York Times says, "An accountant and former computer programmer, he is the shrewd numbers man with a common sense outlook." He is considered to be in a safe seat. On healthcare reform, Enzi says, "We're past due for doing it, and the American people want it," but also says, "I don't think they like what they see so far." Enzi favors the co-op idea and has also sponsored legislation similar to Snowe's that offers small businesses and individuals the right to buy insurance from a national pool. Senator Enzi is firmly opposed to abortion and illegal immigration, so expect that these views will be reflected in legislation that comes out of Senate Finance.
The Gang of Six faces a difficult climb to work out the deatils of reform. Enter the Lone Ranger, President Barack Obama! He has been watching carefully and whether you agree with his ideas or not you have to admit he is maneuvering brilliantly. When the Whitehouse makes their reform proposal it will be with broad support that is guaranteed to pass. It won't have everything he or his supporters want in it, but such is the nature of the political process and compromise.