The Democrats have had a pretty good month.President Bush has been unable tohold Republican legislators on an array of issues ranging from oil drilling tostem cell research. Particularly sweet was the Senate's passage of thepatients-rights bill, with nine Republican defectors voting aye. The vote isawkward for the White House, which has threatened a veto that Bush doesn't reallywant to deliver, and it demonstrates that the managed-care industry isn't 10 feettall. It also shows that Majority Leader Tom Daschle can play hardball--herefused to let the Senate recess for its Fourth of July break until Republicansconsented to a final vote--and whets the Democrats' taste for more victories. Asthe Italians say, l'appetito viene mangiando: The appetite grows the more you eat.
But though Democrats prevailed on the crucial and divisive issue of whether toallow patients to sue HMOs that deny necessary care, the bill is pretty weak tea.It allows doctors to order expensive treatments, including drugs of choice thatare not listed in managed-care companies' formularies. But doctors can do thatnow. The problem not addressed in the bill is the nefarious system of physiciancompensation that HMOs have devised to get doctors to do their bidding.Unapproved medicines, tests, and procedures simply come out of physicians'paychecks. The patients-rights bill does not illegalize this perverse financialincentive, so not much will change in the end.
As our colleague Marcia Angell-- former editor of the New England Journalof Medicine--observed in an op-ed article for The New York Times, what's really wrong with U.S. health care is the fact that insurance is private. The HMO industry takes 20 or 30 cents of every premium dollar for overhead, marketing, executive salaries, and profit. The system pressures insurance companies not to cover the sick but to contain costs at the expense of coverage, prevention, and treatment. Though a useful slap at insurers and a good tonic for Democrats, the patients-rights bill doesn't solve this problem. Only national health insurance does.
To have an eminent doctor such as Marcia Angell come out foursquare foruniversal health coverage creates what psychologists call cognitive dissonance.If a serious person backs socialized insurance, either she's wrong or everyoneelse is. Every sensible politician knows without thinking about it that nationalcoverage is out of the question: too expensive, too much big government, blah,blah, blah. Yet most liberals--like most voters--know that it's what we need. Isit too much to ask that the Democrats lead on this?
Soon, we are likely to witness a similar incremental "victory" on prescription-drug benefits under Medicare. The final compromise will probablyprovide far less than full coverage (and only for seniors, of course) and willduck the essential issue of price controls. As writers Dean Baker and MerrillGoozner have pointed out in these pages, it would make a lot more sense to havegovernment finance more of the research costs and shorten the period of patentprotection, so that prescription drugs would be universally available andaffordable. With the first generation of miracle drugs--penicillin, streptomycin,and the polio vaccine--neither researchers nor drug companies got rich offscientific breakthroughs, and costs stayed low. But such a vision, like that ofnational health insurance, seems beyond the imagination of most mainstreampoliticians. In this issue of the Prospect, Robert Dreyfuss sheds some light on why this is the case: Congressional leaders are in bed with the affected industries.
The Democrats' minimalism on health insurance is emblematic of their narrow,ultimately self-defeating limitations on other issues. Take the matter of budgetand taxes. Ever since the great budget deal of 1997, most Democrats haveconvinced themselves that being the party of fiscal rectitude was both good forthe Democrats' image and a shrewd ploy to prevent the Republicans from passing ahuge tax cut. This had to be the worst strategic miscalculation since the MaginotLine. The fortifications were in the wrong place. Instead of contrasting taxbreaks for the rich with public outlays to benefit the broad electorate--thisstrategy was ruled out as more tax-and-spend--the Dems were blathering on aboutthe (spurious) importance of paying off the national debt. Not surprisingly, thevoters were unmoved and Bush's tax cut subsequently sailed through Congress.
Now, the Democrats are doing it again. Even though the long-term forecastsstill suggest endless and rising surpluses, because of the economic slumppreliminary estimates indicate that revenues will be down and the budget could beslightly in deficit this year. Democrats have pounced on this. You see! Itproves that the Republicans truly are profligate. But this is, again, the wrongissue. Budgets are supposed to go into deficit during a slump. It's spending thatprevents the slump from deepening. The real question isn't whether to allowtemporary deficits but what the differences are in the two major parties' visionand policy priorities for the country. And the deficit-hawk role undermines theDemocrats' ability to think big about what the country needs.
For now, policy minimalism can help energize the Democrats. Small victoriescan build momentum and get the party's lumbering craft headed down the runway.But it will take a much bigger updraft to achieve lift.
