Is there a health care best-case scenario lurking among the ashes of reform?

The Republicans may – just may – be about to be hoisted on their own petard on health care – courtesy of none other than the conservative Blue Dog Democrats in the US Senate.

Even though yesterday’s defeat in the Senate Finance Committee of a public insurance option (which would conceivably provide the cost containment and management necessary to make the expected personal insurance mandate workable) was entirely expected, it was still a blow to reformers’ morale – which is no insignificant thing. With Rahm Emanuel now working organized labor to whittle away the most significant of the remaining institutional resistance to a watered-down bill, it’s hard to imagine that the Obama White House will use its own political muscle to be sure such an option is in the final bill – and right now, its likely its inclusion rises and falls on their commitment.

So what’s left? The nebulous notion of co-ops has been roundly trashed as meaningless or even unworkable. The idea of “triggers” is, of course, ludicrous on its face. Obviously the reason this whole debate was “triggered” is because of a whole sale systemic crisis in the American health care system. What meaningful “trigger” could possibly be created, unless it were one that could fire retroactively… say, 30 years?

But the new “compromise” hubbub emerging from one beseiged Senate Blue Dog Finance Committeeperson – Tom Carper – and similar ideas from Sen. Maria Cantwell, (also on the Finance Committee) could not only be game changers, they could represent an apocalyptic scenario for the Republican Party, depending on how they develop.

Carper’s idea is to give states the option of creating their own competitive option to the private insurance market. Now, tiny states like Vermont with only half a million people could never generate enough of a pool to meaningfully impact costs by negotiating with pharamaceutical companies and the like. This is the same problem that dooms the much ballyhooed co-ops. But if states could be allowed such a buy-in option collectively, that would potentially be a very different story.

What could follow then, is health care reform for some, not all. If Blue States can collectivize their efforts to negotiate prices and impact the market, it won’t take long for enough of a critical mass to form that they have a comparable effect to a full-on public option. Lowly states like Vermont will be very much in the game if their efforts pool with those of New York and California.

Projecting forward, its easy to see what would happen quickly.

This blue-state pool would not simply reap the social and financial benefits of an improved health care system, they would do so at the expense of the red states, as insurance companies could see opportunities to recoup lost profits in those states without a seat at the table. Business, suffering under the burden of health care costs escalating with no end in sight, will find blue states with their cost controlling regimes far more appealing than the red states languishing under the slightly tweaked old system.

And of course, red state voters will start wondering why they don’t deserve the same health care options that the blue staters receive.

All of this could well trigger electoral catastrophe in Republican-dominant states in short order.

And the irony is, of course, that such a scenario is even a possibility because Republicans could not be bothered to come to the policy negotiating table in good faith.

There are a lot of ifs here, and its very early to tell, but should a Carper plan with all these elements emerge, it could be unstoppable. Carper emerged as a key impediment to a robust public option, and his involvement could not only insure majority support, it could take the filibuster talk off the table, as even if there are remaining Dems inclined to join Republicans to prevent an up or down vote, they’ll have very little cover left within their caucus to do so.

Ideas can die in Washington as quickly as their born, but this one – if it does survive, and if it can accommodate the idea of allowing states to pool their efforts – may not only bring actual reform to the health care system, it could become an electoral clusterbomb dropped into the very heart of the Republican Party.

Hard to imagine how many Democrats would want to filibuster that.

One thought on “Is there a health care best-case scenario lurking among the ashes of reform?

  1. I do not expect this to go through either.  The only thing that our leaders, democratic and republican alike, in DC care about is preserving insurance company profits.  That is the only thing that they care about, not the 45,000 Americans that die each year for lack of the means to affordable medical care.  I no longer have hope that anything worthwhile will come out of Washington.  Obama blew it.  

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