As the healthcare reform outlook continues to deteriorate in Washington, D.C., House Majority Leader Steny Hoyer tells us there are 4 choices. Really, though, there are only 2. In fact, I’d say our choice is coming down to one word: both.

 The 4 choices Hoyer lays out are 1) nothing, 2) a vastly scaled-back “bipartisan” bill (read: next to nothing), 3) the House passing the Senate bill, or 4) the House passing the Senate bill with a corresponding bill containing fixes.  Much though Evan Bayh, Blanche Lincoln and the other usual suspects (Anthony Weiner being a very unusual suspect) are talking up #2, we know it’s equivalent to #1. And that is frankly unacceptable.

Matthew Spieler of The Faster Times puts it much more obnoxiously. “I have a question for politicians like Rep. Raul Grijalva, Rep. Anthony Weiner, and the the folks at Firedoglake who would rather kill reform than enact the Senate bill: what kind of health insurance do you have?” He then goes on to tell these folks to drop dead. They have private insurance, and that should be good enough for everyone. Subsidies, which employed folks get through their employers anyway, are the answer, Spieler says.

He entirely misses the point of reform, which is to FIX the mess instead of shoving more people into it, but he does get to an ugly bottom line; for now, unaffordable, unsustainable insurance may be better than none at all. The real name for that is Coverage Expansion, not Healthcare Reform. So if coverage expansion is the objective, what then?

That leaves 2 options, #3 and #4. Nancy Pelosi has already said she doesn’t have the House votes for #3, so we’re down to #4, a tacit “both” corollary to an option not mentioned: passing a bill via reconciliation. Democrats’ unwillingness to explore reconciliation as a real reform tool to put together a quality core bill is a shame, although it’s understandable. As we’ve covered before, it’s a real crap shoot undertaken by a very unstable political base.

If a reconciliation bill contains anything that’s not strictly a budget issue, Republicans can challenge it and tie up the whole process. That’s hugely risky, flirting with option #1. Instead of a very flawed Senate bill that is at least a weak and shaky first step, we could have nothing. Plus the politicians who created the current flawed bills are mostly the same ones who will be involved in a reconciliation bill – not a formula for any really different content.

Also, the longer this process goes on, the less chance any reform will pass. Voters are already extremely suspicious of the cloak-and-dagger tainted political deal-making we’ve witnessed thus far. If any more comes to light healthcare reform will be dead in the water. Lastly, Democrats are running scared now. Instead of focusing on what needs to get done, they are worried about their re-election chances. Altogether it’s not a pretty picture for starting over with reconciliation.

So I am reluctantly on board with the House passing the Senate bill, with reconciliation to fix the major flaws. My vote for “both”, however, rides on the reconciliation bill being drawn up in concert with the passage of the Senate legislation. Any promise to fix it later can be interpreted as a “trigger” type plan, which means it will never happen.

Also, reconciliation needs to include more than just fixing the excise tax, closing the Medicare Part D doughnut hole, and middle-class premium subsidies. It needs Medicare expansion re-inserted as the easiest “public option as a budgetary fix” ploy. After all, the infrastructure for Medicare is already in place, meaning the only changes are in revenues and costs due to changes in eligibility age.

It also needs effective dates moved up, so real insurance changes are visible ASAP. Otherwise election results are already pre-determined, and we can look forward to Republican initiatives to roll back healthcare reform legislation. If the public hasn’t seen any benefit, politicians won’t encounter any resistance. In short, it’s time for Democrats to be brave, and we need to support them for it or punish them for continuing their Chicken Little performances.

Tell your House and Senate representatives to keep real healthcare reform moving forward. The Center for Policy Analysis is sponsoring a petition at Change.org — sign it here.

UPDATE: Pelosi is confirming the “both” strategy, and divulging some details in The National Journal.

Photo Credit: ShellyS

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