Barney Frank on health care reform

My Congressman, Barney Frank, sent a lengthy message to those who wrote to him about health care reform. (My email included the phrase PASS THE SENATE BILL three times.) He is not only a Washington insider, but an extremely thoughtful and intelligent man. His words are, I suggest, worth pondering even if you don't necessarily agree with everything he has to say--as I don't, or at least didn't before I read what he has to say. Here are some of his thoughts:

Substantively, I support legislation to provide universal coverage. My own preference would be a single-payer system. I believe that the Medicare system - in which I am now enrolled and have been for several years - works better than the private insurance systems, although it is obviously not perfect and needs some changes. But I also recognize that we are not close to having the support in the country that I wish we had for a single-payer system, and therefore we should do what we can achieve. I believe that the Massachusetts system has worked, on the whole, better than what existed before, and one of the things in favor of the federal bill, in my mind, is that it does somewhat approach the Massachusetts system. I am troubled, I should add, in general, by the notion of a mandate on people to buy healthcare plans, and I would have preferred something that avoided this, but I believe that something of this sort is necessary because a great number of the reforms that are very desirable - and broadly supported - cannot go forward unless we are able to broaden the base of those who are being insured.

Having voted my approval of the concept of the general healthcare bill, I also want to express my differences with some aspects of what both houses passed, but particularly with the Senate bill. I disagree with the notion of taxing healthcare plans as taxable benefits. In an ideal world starting from scratch, that might make sense. In the world in which we live, where people have traded off higher wages for healthcare benefits and there are economic interests built in, I think it would be a mistake. I preferred the House proposal of raising revenues that were needed by increasing taxes on incomes above a certain level - I thought above $350,000 was appropriate, although in the end the House was only able to get support for a figure of $1 million.

I also prefer the House position of having a national exchange rather than a number of individualized exchanges, because I think the more that you broaden things here, the better off we all are. I was therefore hoping that there would be a conference between the House and the Senate to merge the bills and particularly retain those parts of the House bill where I prefer it to the Senate bill.

Until the election of Senator Brown, it seemed clear that the best way to proceed, in my judgment, was to negotiate a compromise between the bills and have it pass both the House and the Senate, with the Senate, of course, requiring the 60 votes that the filibuster rule, unfortunately but for now firmly, required. Then came the election of Senator Brown and the procedural questions that I referred to arose. I was troubled, to be honest, to hear some of my colleagues suggest that there might be some procedural shortcuts that would allow us to proceed after the election of Senator Brown, as if his election had not occurred. I do not believe that there was ever any realistic proposal to delay seating him solely for the purpose of allowing a compromise bill to be rammed through, but because it had been raised, I did speak out very harshly against it. I must say that I think it was more being forwarded by extreme conservative media than any realistic plan, but nonetheless I did want to repudiate it. I also spoke out against what I thought were some ideas about bending the Senate rules on the arcane procedure of reconciliation, so as to be able to do more with only 51 votes than is currently possible with 60. I want to be clear that I think the filibuster rule is a grave error, and I was for changing it back when the Democrats were in the minority and were using it as long as it was changed, not just for judicial nominations, but for all issues. But I do not think you should force changes in a particular procedure solely for one issue, and that is why on the Tuesday night of Senator Brown's election, I spoke out against what I thought were some proposals by some Democrats to manipulate the rules to get the bill through.

Several people who share my support for the substance of the bill have been critical of my objecting to certain procedures that they felt would work to pass the bill. My response is two-fold. First of all, it was clear by the day of Brown's election that if he were elected, there would be no way they'd simply get the House to accept the Senate bill. Some Members of the House were opposed to it because it did not sufficiently ban abortion. Of course, I was on the other side of that, but that did not mean that their votes would change. Beyond that, there were serious principal objections, which I shared, to several of the corkscrew provisions of the Senate bill, which were bad policy and bad procedure. Given this, I believe it would have been a great mistake to have tried to force things, because it would not have resulted in a bill being passed, and it would have added to the sense that we didn't feel that things are being done fairly. Increased anger and alienation from the government, and frankly from those of us now in the majority, are not in my judgment in the interest of either the country as a whole or trying to get a healthcare bill.

That leads us to the present situation. I have told the House leadership that I support an effort to pass as much of the healthcare bill as we can - and I refer here to the substantive bill without some of the Senate's obnoxious deals in it. Many have argued that it would be relatively easy to take those provisions reforming insurance - protecting people with pre-existing conditions, opposing any lifetime cap on reimbursements etc. - and passing them into law. But they would require either a sharply higher degree of regulation of insurance companies for which the support does not now exist, or an expansion of the pool of the insured, or a sharp increase in premiums. None of the three seem to me acceptable and so the question is, how can we find a way to continue with our efforts to expand the pool of those getting insurance so that we can get these other benefits. We can do some things with regard to the anti-trust exemptions that the insurance industry enjoys, and as I compose this letter, we are planning next week in the House to pass legislation that would take away the anti-trust exemptions. I think those are clearly in the interest of controlling healthcare costs and providing better choices for consumers.

Finally, I should add that I am not the best source of what exactly the current state of the negotiations is. As Chair of the Financial Services Committee, my main job for the last year and a half has been to put tough new financial reform regulations in place. I am now awaiting the Senate action, and I am concerned that some of what is going on in the Senate may weaken the bill in ways that are unwise. I did stand with President Obama and former Federal Reserve Chairman Paul Volcker two weeks ago to support the proposals Mr. Volcker had made, and in fact as he acknowledged, elements of the bill that passed the House under my chairmanship set the groundwork for those. But because I have been as focused on these, I have not been a participant in the healthcare discussions. I have made it clear to the Speaker that my vote will be there to adopt the most elements that we can of a comprehensive bill and of course the problem will be figuring out what can be done in the Senate. There is a legitimate role for the reconciliation process, which requires only 51 votes - 50 Senators and the Vice President if necessary - but the problem here is that only some subjects are allowed to be considered under this procedure and not others.