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47 (Now 51) Health Policy Experts (Including Me) Say “Sign the Senate bill.”

Harold Pollack is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.

At a low moment of the Second World War, a breathless young aide barged in on Winston Churchill to report some bad news. Showing the aplomb one fully achieves only within the pages of one’s own memoir, Churchill quotes himself responding: “I’ve heard worse.” That’s the resilience Democrats need.

Treatment readers already know that many health policy experts across the political spectrum support House passage of the Senate bill, with an accompanying fix of the bills various shortcomings through the reconciliation process. Like Paul Krugman, Jonathan Cohn, Ezra Klein, and Jacob Hacker, Tim Jost and I very much agree that this is the best approach.

Yesterday, Tim and I crafted a simple letter (shown below), which we emailed other health policy experts we know. Some are progressives who identify with a single-payer approach. Others are more politically moderate economists, sociologists, and political scientists. Still others identify with organized labor, medicine, or public health.

Within several hours, many outstanding scholars, activists, and practitioners signed on. Signers include Henry Aaron, David Cutler, Jon Gruber, Theda Skocpol, Paul Starr, and many others, including Anna Burger, Secretary-Treasurer of SEIU.

Some people we contacted could not sign on, but reported that they are seeking the same goal through more private means. Virtually no one we contacted disagreed with this letter on either political or policy grounds. Our letter represents a broad consensus of those supporting health care reform.

We are so close to enacting a historic reform. Now is the time for calm and resolute Congressional action. The Massachusetts election was a setback. Democrats still have large majorities in both the Senate and the House. We’ve heard worse. It’s time to act.

22 January 2010

Congresswoman Nancy Pelosi
Speaker of the House of Representatives
235 Cannon House Office Building
Washington, DC 20515

Congressman Charles Rangel
Committee on Ways & Means
U.S. House of Representatives
1102 Longworth House Office Building
Washington D.C. 20515

Congressman Henry A. Waxman
Committee on Energy and Commerce
2204 Rayburn House Office Building
Washington, D.C. 20515

Congressman George Miller
Committee on Education and Labor
2205 Rayburn House Office Building
Washington, DC 20515

Dear Speaker Pelosi and Chairmen Rangel, Waxman, and Miller:

For nearly three-quarters of a century, Presidents and Congressional leaders have tried to enact legislation that would make health care accessible to Americans. Although pieces of this dream have been realized—health care for the elderly, the disabled, and children in low-income families—universal coverage itself has proved beyond reach.

We are now on the cusp of realizing this goal. Both houses of Congress have adopted legislation that would provide health coverage to tens of millions of Americans, begin to control health care costs that seriously threaten our economy, and improve the quality of health care for every American. These bills are imperfect. Yet they represent a huge step forward in creating a more humane, effective, and sustainable health care system for every American.

We have come further than we have ever come before. Only two steps remain. The House must adopt the Senate bill, and the President must sign it.

While the House and Senate bills differ on specific points, they are built on the same framework and common elements—eliminating health status underwriting and insurance abuses, creating functioning insurance markets, offering affordability credits to those who cannot afford health insurance, requiring that all Americans act responsibly and purchase health insurance if they are able to do so, expanding Medicaid to cover all poor Americans, reforming Medicare payment to encourage quality and control costs, strengthening the primary care workforce, and encouraging prevention and wellness.

Some differences between the bills, such as the scope of the tax on high-cost plans and the allocation of premium subsidies, should be repaired through the reconciliation process. Key elements of this repair enjoy broad support in both houses. Other limitations of the Senate bill can be addressed through other means.

The Senate bill accomplishes most of what both houses of Congress set out to do; it would largely realize the goals many Americans across the political spectrum espouse in achieving near universal coverage and real delivery reform.

With the loss of Edward Kennedy’s Senate seat, Democrats no longer enjoy a filibuster-proof Senate majority, though they still enjoy the largest Senate majority any party has achieved in the past generation. The loss of this one vote does not require Congress or the President to abandon Senator Kennedy’s life work of health care reform. A year of political infighting, misleading debates about death panels and socialized medicine, and sheer inaction has left Americans exhausted, confused, and disgruntled. Americans are also bearing the severe consequences of deep recession and unemployment. Still, a majority of Americans support the elements of the Senate bill. 

The House of Representatives faces a stark choice. It can enact the Senate bill, and realize the century-old dream of health care reform. By doing so, it can achieve a historic milestone while freeing itself to address other national problems such as joblessness and mortgage foreclosure that affect millions of Americans. Differences between the House and Senate bill can be negotiated through the reconciliation process. 

Alternatively, Congress can abandon this effort at this critical moment, leaving millions more Americans to become uninsured in the coming years as health care becomes ever less affordable. Abandoning health care reform—the signature political issue of this administration—would send a message that Democrats are incapable of governing and lead to massive losses in the 2010 election, possibly even in 2012. Such a retreat would also abandon the chance to achieve reforms that millions of Americans across the political spectrum desperately need in these difficult times. Now is the moment for calm and resolute leadership, pressing on toward the goal now within sight.

Some have proposed dividing the bill or starting anew with negotiations to produce a less comprehensive bill. From the perspective of both politics and policy, we do not believe this is a feasible option. We doubt that the American public would welcome more months of partisan wrangling and debate. We doubt that the final product would match what has already been achieved. Indeed we doubt that any bill would reach the President’s desk should congressional leaders pursue this misguided course.

We, the signatories of this letter, come from a variety of different perspectives. Some of us are long-standing advocates of progressive causes. Some of us are nonpartisan or identify as political moderates.

From these differing perspectives, we agree on one thing: the current choice is clear. Pass the Senate bill, and improve it through reconciliation.


Henry J. Aaron, The Brookings Institution
Gerard Anderson, Johns Hopkins University
Ronald Anderson, UCLA
Dean Baker, Center for Economic and Policy Research
Ronald Bayer, Columbia University
Anna Burger, Secretary-Treasurer, SEIU
David Cutler, Harvard University
Linda C. Degutis, Yale University
Judith Feder, Georgetown University
Eric Feldman, University of Pennsylvania
Thomas Fisher, University of Chicago
Brian R. Flay, Oregon State University
David Grande, University of Pennsylvania
Thomas Greaney, St. Louis University
Colleen Grogan, University of Chicago
Jon Gruber, MIT
Mark A. Hall, Wake Forest University
Jacob S. Hacker, Yale University
Jill Horwitz, University of Michigan
James S. House, University of Michigan
Peter Jacobson, University of Michigan
Timothy Jost, Washington and Lee University (organizer)
Theodore Joyce, CUNY
George A. Kaplan, University of Michigan
Jerome Karabel, University of California at Berkeley
Mark A.R.. Kleiman, UCLA
Paula M. Lantz, University of Michigan
Simon Lazarus, NSCLC
Arleen A. Leibowitz, UCLA
Theodore Marmor, Yale University
Lynda Martin-McCormick, NSCLC
Michael L. Millenson, Northwestern University
James A. Morone, Brown University
Len Nichols, New America Foundation
Jonathan Oberlander, University of North Carolina at Chapel Hill
Mark A. Peterson, UCLA
Karen Pollitz, Georgetown University
Harold Pollack, University of Chicago (organizer)
Daniel Polsky, University of Pennsylvania
Sara Rosenbaum, George Washington University
Meredith Rosenthal, Harvard University
Lainie Friedman Ross, University of Chicago
William Sage, University of Texas
Theda Skocpol, Harvard University
Paul Starr, Princeton University
Donald H. Taylor, Jr., Duke University
William Terry, Brigham and Women's Hospital
James A. Tulsky, Duke University
Alexander C. Wagenaar, University of Florida
Joseph White, Case Western Reserve University
Celia Wcislo, 1199-United Healthcare Workers East, SEIU

(Institutional affiliations listed for identification only).

cc. Senator Harry Reid

  President Barack Obama