Harkin: Think of health care reform as a starter home

U.S. Sen. Tom Harkin has advice for progressives frustrated with the prospects of meaningful health care reform in the U.S. Senate: Think of it as a starter home.

“What we are buying here is a modest home, not a mansion. What we are getting here is a starter home. It’s got a good foundation: 30 million Americans are covered. It’s got a good roof: A lot of protections from abuses by insurance companies. It’s got a lot of nice stuff in there for prevention and wellness. But, we can build additions as we go along in the future. It is a starter home. Think about it in that way,” Harkin said by telephone Thursday morning.

Harkin said he spoke Tuesday with former Vermont Gov. Howard Dean, who has publicly advocated for the Senate bill to be scrapped and for Democrats to begin a reconciliation process to pass a new bill that includes either an expansion of Medicare or, preferably, a public option. Without the public option, Dean has said the bill is not worth Democrats’ support.

“I think [Dean] is speaking to the frustration of many of the progressives in this country who recognize what I think is sort of the common sense approach of having at least one public option out there,” Harkin said.

“I think there is a lot of frustration out there — I have it myself. But you can’t let frustration turn into defeat.”

One of key reasons Harkin, who has pushed repeatedly for a robust public option, continues to support the bill is for the prevention and wellness provisions it contains.

“The medical community, the public health community and others interested in wellness realize that it is a big deal to get this in the bill. We lose all of that if we go to reconciliation — all of the insurance reforms on pre-existing conditions, and no lifetime caps, and no gender discrimination — we lose all of that,” Harkin said.

Although Dean believes that such provisions can be recaptured later, through subsequent amendments and modifications of a final health reform bill with a public option, Harkin is adamant that the changes must be made now.

“I told [Dean] that we have trouble passing a resolution saying there are seven days in the week,” he said, labeling the current Republican policy of using as much floor time as possible on every bill as “scorched earth.”

“What are we up to, 90 filibusters now? It means it has gotten to the point where everything has to be filibustered — everything. We have a defense appropriations bill on the floor right now that would probably get 90-plus votes … yet it is being filibustered,” he said. “In September we had the extension of unemployment insurance. It took us three weeks to get it to the floor, and then it passed 100 to nothing. Why would that take three weeks? It wasn’t amended. It wasn’t changed. It just took three weeks. That is what is happening.”

Yet if the “starter home” version of health care reform can be approved, Harkin remains confident that it will ultimately be the demands of the people that result in changes, additions and enhancements.

“Once you break the [special interest] stranglehold and you get the architecture in place, then it is not a massive reform to change this or add this or modify that,” he said. “My hope is that we move ahead on this and as reforms are in place, people will begin to say, ‘Gee, I didn’t realize that was what they were talking about.’ As more and more of these reforms take place, people will say that this is good, but we need something else, to change this or do that.

“In the future, amending it and changing it isn’t going to be as tough as passing it in the first place. We amend Medicare and Social Security all the time. We are changing rates, fixing this, doing this to make sure that they are viable. That’s what we will do in health care. I’m absolutely convinced of it.”

And there is one other thing Harkin is convinced will eventually come to pass: A public option.

“At some point in the near future, and I don’t know exactly how long it is going to be, we are going to have some sort of a public option out there,” he said. “We might not get it in this bill, but it will come in as the years go by and as people begin to look at insurance companies and how much they are charging. I have no doubt in my mind that we are going to have to go to some kind of a public option, some type of a single-payer type system to bring the costs down. When the administrative costs of Medicare is somewhere around the 3 percent range, but the administrative costs of the private insurance companies are in the 15 percent range, there is a lot of money that can be saved by going to a better system such as a single-payer or a public option-type system.”

Although Harkin expressed his disappointment with U.S. Sen. Joe Lieberman‘s hard-line stance against the public option and a Medicare expansion, he was not ready to speculate if the move would ultimately cost the Connecticut Independent his Homeland Security Governmental Affairs Committee chairmanship .

“I only have one interest right now, and that is getting this bill done. Getting it over the hurdle,” Harkin said. “We are all miffed a little bit because we had made those compromises. We got rid of the public option and we put in the Medicare buy-in at 55, which [Lieberman] had supported as recently as two months ago. We thought we had a deal. And then, last Sunday, he came out and said he was opposed to that also. It’s no secret that we were upset about that, but you move on in life. … I’m not mad, I just want to get this thing done.”

The Senate version of reform, according to Harkin, would provide Americans immediate provisions to ease the current health care burden. For instance, tax credits — up to 35 percent — will go into effect next year, as well improved access to insurance for people with pre-existing conditions. Children will be able to remain on their parents’ insurance policy until age 26, and insurance companies will be prohibited from rescinding the policies of people who become ill.

Regardless of all the jockeying within the Senate, Congress is still several weeks away from placing a final health care bill on the president’s desk. Even if the Senate was able to mesh out a compromise this week, the bill would need to be merged with the U.S. House version by a conference committee. Most interested parties anticipate that the merger will bring significant changes to both bills, and then the members of Congress will need to re-approve the merged bill.

“[Conference is] another hurdle we have to get over,” Harkin admitted. “But I always say ‘Cross one bridge at a time.’”