The fate of Barack Obama’s health care agenda may hinge on a man who, when it was time to assemble a White House team, the president pointedly ignored.
That would be Howard Dean, whose desire to run the Health and Human Services Department—and, thus, to be the administration’s most visible face on health care—was never seriously entertained by Obama and his advisers.
Dean’s role now is that of a peacekeeper. The reform effort is under threat from 60 members of the House Progressive Caucus positioning themselves in opposition to the compromise bill that party leaders hammered out last week with the conservative Blue Dog Coalition. Too much was bargained away, the progressives fear—especially when it comes to the public option.
That’s not how Dean sees it. To craft a final bill that will appeal to all Americans, the input of moderates and conservatives is needed, he says, and since Republicans don’t want to participate, “the Blue Dogs are actually not just the next best thing, but the best thing, because they are loyal to the idea of having a bill and they are Democrats.”
The House compromise, he insists, left the most critical aspects of reform alone.
“The public option, which is the essential part of reform, was left intact,” Dean said. “I think it was somewhat improved; you really can’t pay Medicare rates. They did a lot for small businesses, which was an original part of Obama’s plan.
“They hiked the payroll ceiling to $500,000, and exempted small business from having to pay any kind of mandate underneath that—which is very, very important because small business creates 80 percent of all new jobs.”
To be sure, many on the left vehemently disagree with this assessment. But this is why Dean’s attitude is so significant, and potentially critical.
To the Democratic grass roots, he’s not just another public figure; he’s a folk hero, a reputation he earned with his early opposition to the Iraq war and enhanced during his four-year run as D.N.C. chairman, when he stood with grass-roots activists and weathered the enmity of the party’s Washington establishment. So if there’s anyone who can hold the hand of progressives and coax them into accepting compromise with the Blue Dogs, it’s probably Dean.
Dean’s appetite for compromise ends the instant a public option is taken off the table. So he’s happy to blast the bipartisan alternative that members of the Senate Finance Committee are drafting at a snail’s pace—a plan that would utilize nonprofit cooperatives instead of a government-run insurance option.
“The compromise that’s being proposed by these six senators is destructive, foolish and would be a very bad bill,” he said, stressing that he wants the Senate to adopt the plan already approved by the Health, Education, Labor and Pension Committee.
And he’s willing to write off any further outreach to Republicans—“The Republicans are interested in using this as a wedge to hurt Obama. Last time I looked, that didn’t come under the heading of serious public policy”—and to declare, “We’re going to this inside the Democratic Party.”
The inclusion of a public option in any final plan is a bottom-line issue for progressives, and they know Dean shares their view. In fact, Dean’s Web site, which features a running tally of Congressional opinion on the public option, has become a vital tool for grass-roots activists. To those who fear the House compromise defeats the purpose of the public option, Dean replies that the most important thing is that the fundamental concept be part of the final package.
“In general, the individual market has a lot more problems than the big group market, and as long as you allow people to have a choice in the individual market, that’s a good start,” he said. “Ultimately, the employer-based health care system harms our economy. But people are not ready to give up the employer-based system, and that’s why this choice is so important.”
There is, of course, a long way between here and a White House signing ceremony. The House still has to vote on the compromise bill, which if it passes would then have to be reconciled with a Senate version—which could be the HELP Committee’s bill that Dean supports or the Finance Committee compromise that he opposes. Or, if Republican obstructionists get their way, there might be no Senate bill at all.
But the House Democratic leadership’s deal with the Blue Dogs last week confirmed that the “pure” public option that many on the left dream of won’t be part of any final bill. There are simply too many moderates insisting that it be watered down. But the bill won’t get anywhere if the members of the Progressive Caucus follows through on its threat and digs in its heels. How to soothe them?
Pelosi got off to a very bad start last week, when she seemed to ridicule the progressives’ threat at a press conference. But Dean may have the clout and credibility to keep them on board and to stave off an intraparty brawl that would jeopardize reform. If he can pull that off, the White House will owe him, for starters, a big thank you.