SO NEAR, yet so far. As President Obama struggles to make his mark on global issues of war and peace in Oslo and on climate change in Copenhagen, at home his flagship reform of healthcare stumbles and threatens to fall apart. Although a version of the reform package has been passed by the House of Representatives, Democrats in the Senate remain locked in a complex negotiation process to pass an $848 billion Bill before the Christmas recess. If passed, the two congressional Bills will have to be reconciled in a process involving further unpalatable compromises.
To his credit, Mr Obama has already got far further into the reform process than any predecessor. But that will be cold comfort if it succumbs to congressional gridlock now or, as many Democrats fear, becomes so emasculated that only the barest vestige of what they voted for remains. More than 46 million Americans are now without insurance – both Bills would extend cover by 30 million. Yet more millions have such poor coverage that severe illness threatens bankruptcy and, without reform, the Commonwealth Fund research group warns that the average family premium in employer-sponsored policies – part-employer, part-employee paid – will double in 10 years, from about $12,300 to $23,800.
The threat of gridlock comes from the Senate’s procedural requirement of a “supermajority” of 60 votes out of 100 to block a filibuster, and the extraordinary power that bestows on a handful of centrist members. A number of hurdles remain to be overcome – yesterday, the first, an amendment to allow importation of cheap prescription drugs from abroad. Though widely backed in Congress, it could jeopardise a White House agreement with drugmakers that has helped to ease healthcare industry opposition to the Bill.
And then there is the proposal from Senate Majority Leader Harry Reid as a substitute for the so-called “public option”, already substantially gutted to the disappointment of the left which still threaten to block the Bill if it is not there. Reid’s scheme would extend insurance provision for the elderly, Medicare, to those between 55 and 65 who cannot afford cover. On Sunday Independent Connecticut Senator Joe Lieberman dropped a bombshell by announcing he would oppose the compromise. Without him, to reach 60, the Democrats will need to enlist Republican Senator Olympia Snowe of Maine, also sceptical of the Medicare idea.
Others are awaiting a report from the congressional budget office on the costs of the Medicare option before pronouncing, while Nebraska Democrat Dan Nelson is holding out for an amendment to ban federal funds being used to subsidise policies that would cover abortion.
Congressional bickering has also prompted a disastrous waning in public support – the latest aggregate poll records 53.5 per cent opposition to 38.4 per cent support for the reform package. A slippage in the agenda into 2010 is likely to make matters worse. Yet America desperately needs its healthcare reform.