What do you do when you are a U.S. senator and the president wants you to vote for a health care bill that could radically change health care?
You ask questions. You hold hearings. You understand what it would mean to your constituents. You listen to those who know the system. And when it doesn’t add up, you vote against it.
The year was 1979, and I was a freshman Republican senator from Minnesota. Inflation was driving the already high costs of health care through the roof. President Carter wanted to use Medicare and Medicaid to limit increases in hospital budgets in the face of rapidly inflating costs.
Ultimately, I decided to vote against it as it would end up hurting the people of my state and was inconsistent with my beliefs. And then, after the vote, we — Democrats and Republicans — launched an effort to learn how best to change the cost curve of the entire health system by focusing on how we pay for Medicare.
This week, the Senate once again is set to vote on a health care bill that will radically change how people get coverage and who can afford their care. But unlike normal times, Senators, you are being asked to approve a Motion to Proceed to a vote:
- Without knowing what will be in the bill you would vote on.
- Without knowing what the non-partisan Congressional Budget Office will say about the impact of major amendments and the final bill on coverage and premiums.
- With full knowledge that the Senate parliamentarian, who rules on what can and can't be allowed in a budget bill, has said that the Senate must remove provisions intended to prevent an insurance market death spiral of sicker patients driving up costs.
- Without knowing the details of the secret state Medicaid waivers the Trump administration insists will make the bill work.
- Without knowing how your own state budget will be impacted.
- Without knowing how you will defend the provisions you will only learn about later, including the payoffs and other things that will be sneaked into the bill at the last minute.
- Without even knowing which bill you are being asked to vote on, what the defining amendments will be and how much time you will have when being pressed for a final vote you’ll be stuck with. Forever.
A vote in these circumstances will rightly provoke anger and distrust unlikely to abate. Take it from me: A no vote on the Motion to Proceed this week is the only one that will be defensible in the years to come.
I have had my arm twisted by the best of them — presidents and Senate leaders and party whips alike. I know how uncomfortable it can be. Usually, they were able to attempt a convincing argument about what is good about the bill for the country or my state. But I never would have voted for something so far reaching without knowing the answer to all the questions above.
Never in all my years did I experience the level of bullying we see today. It doesn't look good in Minnesota, and I suspect it doesn’t look any better in your state.
I know that some of you ran for office vowing to repeal the Affordable Care Act, hoping to improve coverage and decrease costs. As public opinion polls tell us, voters do not believe this bill does the job. The good news is we haven’t run out of time to ask questions and to work together to fix what needs fixing if we take the time to return to regular order and hold hearings.
Seven years ago, Democrats supported a bill far from Democratic orthodoxy. It did not provide for single payer, nor Medicare for all. Not even a public option. They handed Republicans a chance to build a health system that plays to our unique strengths as a nation, not to our weaknesses.
As someone whose efforts earned the support of both Presidents Ronald Reagan and George H.W. Bush to reduce health care costs without leaving anyone behind, I know our party can do much better. But it should be obvious to all of you listening to your constituents that voting on this hodgepodge of mysterious bills is not the way.
Because there are no do-overs. The vote for the Motion To Proceed is likely a vote for final passage, and the House clearly stands ready to pass the Senate bill unchanged.
There is no making good on all of the issues later. Once the funds for health coverage are gone, it will take new tax increases to replace them. And what’s the likelihood that will happen?
There will be no hiding this vote. Let me assure you, as the official scorekeeper, the CBO will eventually score the entire bill, and that’s what your vote will be evaluated on.
For those who worry about re-election politics, I can assure you that going into a campaign confident that you've done what’s best for every one of your constituents, not just for those who want to stick you with a stale slogan, is the best medicine you’ll ever have prescribed for you.
David Durenberger, a Republican senator from Minnesota from 1978 to 1995, is a former chairman of the Senate Finance subcommittee on health. He retired in 2014 as chairman of the National Institute of Health Policy at the University of St. Thomas.
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