THE GULF between Republicans and Democrats over reform of the US’s dysfunctional healthcare system remains an unbridgeable abyss. Thursday’s seven-hour TV “summit”, organised and chaired by President Obama, simply rehearsed familiar entrenched positions without narrowing that gap. And with a bipartisan deal now not an option, Democrats have little choice but to go it alone or miss the opportunity of a generation to see through their president’s flagship programme.
House Republican leader John Boehner may have insisted the US has the “best health care system in the world” though both parties agreed the system is broken, but the scale of ambition of their irreconcilable plans are simply of different orders of magnitude – Democrats would extend coverage to 30 million of the uninsured, and the Republicans only to some three million.
Mr Obama’s 10-year plan, costing roughly $900 billion, seeks to extend and guarantee the right to cover but the Republicans again accused him of profligacy and attacked the tyranny of requiring individuals to buy insurance. Their’s are small-scale solutions such as encouraging competition by allowing consumers to buy insurance across state lines. But without minimum standards, which they oppose, the result could be a rush to the bottom by companies offering cheaper and cheaper cover but covering less and less.
In opposing an Obama requirement on companies to accept clients irrespective of their medical history, critics say the Republicans would allow the insurance industry to continue cherry-picking clients instead of pooling risks broadly across the population. For those excluded, the costs of insurance, even if subsidised by the state, would simply spiral.
Now the Democrats, short of abandoning reform, have no alternative but to use their majorities in both houses to push reform through. In theory they could simply get the House to pass the Bill agreed in the Senate, though their own ranks are reluctant; or could dismantle it and put measures through piecemeal, albeit jeopardising key elements.
The party lost its filibuster-proof 60 per cent majority in the Senate in the byelection to replace Senator Ted Kennedy, but the filibuster can be circumvented. A simple majority is all that is required in a process known as “reconciliation” in which the Bill passed by the Senate is subject to limited amendment to make it acceptable to the Democratic majority in the House. It is now the course most likely to be taken.
Republicans are already screaming blue murder, accusing Mr Obama of undermining democracy. But reconciliation has been used repeatedly by them in the relatively recent past to push through health Bills and both the controversial Bush tax cuts (at a budget cost of $1.8 trillion, twice that suggested for health reform).
The reconciliation option will certainly raise the political temperature. Republicans see the unpopular reforms as a sure vote winner for the mid-term elections in the autumn. But the opportunity open to Mr Obama will slip away for certain unless he presses ahead now.