Pelosi Unveils a Ground-Breaking Health Care Plan -- Will Senate Dems Follow Her Lead?

In the annals of health-care reform, this week was a doozy -- perhaps the doozy of doozies. It began with Senate Majority Leader Harry Reid surprising reporters with the promise of a public health-insurance plan in the Senate's health-care reform bill, and ended with House Speaker Nancy Pelosi unveiling a health-care bill that is almost (dare we say it?) progressive.

In between the two announcements was a whole lot of hand-wringing about whether Harry Reid's public option was for real-for real -- whether he really had the 60 votes he'd need to shut down a promised Republican filibuster that would keep his bill from ever reaching the Senate floor. (Answer: not yet.) 

While the odds-layers in Washington speculated over the party loyalty of Democrats from red states -- Mary Landrieu of Louisiana, Blanche Lincoln of Arkansas, Ben Nelson of Nebraska -- the ever-"independent" and always irritating Joe Lieberman of Connecticut stepped forward and threatened to step on Reid's birthday cake by joining with Republicans to prevent a vote on the bill.

And there you had the Senate doing what the Constitution built it to do: dither. And perhaps no Congress has better fulfilled that constitutional mission than this one, having dragged us through the Summer of Heckle, Jeykyll and Jive as Finance Committee Chairman Max Baucus, D-Mont., sought the elusive vote of one Republican, hoping to put the "bi" in bipartisan.  And there's more dithering ahead, as the Senate waits for the Congressional Budget Office to analyze the costs of various provisions that may or may not survive to a final bill, which may or may not see a final vote.

Throughout the summer and fall, Reid has endured the relentless pressure of progressives to include a public option in his plan, facing television ads in his home state from the Progressive Change Campaign Committee as he gears up for a difficult re-election campaign. The Majority Leader looked tense on Monday as he announced his intention to include a modest public option in the Senate bill, one from which states could opt out via their own legislative process -- not an easy hurdle for most naysayers to cross.

Yesterday, bounding down the Capitol steps came House Speaker Nancy Pelosi, bill in hand, complete with a public option. So, okay, it isn't the "robust" public option promised to AlterNet readers by Ways and Means Committee Chairman Charles Rangel, D-N.Y., this summer, but it doesn't include that silly opt-out plan. Unlike the lonely Harry Reid, who stood alone to face reporters on Monday, Pelosi was surrounded by members of her caucus, all smiles. Implicit in her timing was a message to the Senate: Keep noodling all you want, but here's a bill, a decent bill -- the bill we're gonna pit against yours in a conference committee if you ever get around to passing one.  So, you might want to hop to it. And the more yours looks like ours, the easier it's gonna be for all of us.

The public option for which Pelosi settled is one designed to placate her Blue Dogs -- the conservative Democrats, mostly from rural states, who had opposed any meaningful form of a public option at the onset of negotiations. They, too, were the targets of progressive pressure, especially as polls showed support for a public plan in several of those blue-dog states, and liberal bloggers exposed the levels of campaign donations they received from the health industry sector.

What was called a "robust" public option would have tied the reimbursement rates paid to providers in the public insurance plan to the rates paid by Medicare. Partly because providers in rural states receive a lower rate of reimbursement than those in more urban states, the Blue Dogs howled at that notion. It's said that the Blue Dog compromise ads another $85 billion to the bill's cost, but it still doesn't add to the deficit, Pelosi claims.

The deficit neutrality of the House bill presumably wins the support of the White House, while the less-than-robust public option seems to have passed muster with the big labor unions, who are surely influenced by another important distinction between the House and Senate bills: the House bill helps pay for itself through a new tax on the nation's most well-off citizens, while the yet-to-be-finalized Senate bill will likely pay for part of its cost by taxing high-priced, fully-loaded health-care plans -- like the plans many unions have negotiated in lieu of salary increases (and even as trade-offs for give-backs) by their members. Within hours of Pelosi's unveiling, both the AFL-CIO and the Service Employees International Union (SEIU) released statements praising the House bill.

Of course, Pelosi's chamber saw some drama, too, in the week that led up to her triumphant unveiling of H.R. 3962, the Affordable Health Care for America Act. Between the horse-trading that took place behind closed doors, the House's two health-care reform tigers, Rep. Alan Grayson, D-Fla., and Rep. Anthony Weiner, D-N.Y., trash-talked harlots and Happy Meals before everybody kissed and made up. Much more amusing, though, than the Senate's sanctimonious fretting, threats and dithers.


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