When you take pains to define yourself as a middle-of-the-roader and a compromiser, as Arkansas’ two U. S. senators have done, there is bad that comes with the good. Hardly anyone despises you, and everyone cherishes a fond hope that you will finally land on his side on the burning issues. That is the nice part.
Like no other tandem in the Senate, Blanche Lincoln and Mark Pryor now appreciate the distressing side of the carefully crafted “moderate” image. In an evenly divided Congress that is confronting issues of biblical consequence, most of the weight of the national striving lands squarely on you. The pressure groups from all sides focus their efforts on you and, even more perilously, your voters.
When the issue arose whether to re-balance the scales between management and unhappy employees to make it easier for workers to bargain with the company through a union, business and union groups waged big campaigns to persuade Arkansans that Pryor and Lincoln would either destroy or guarantee worker rights by their votes, both sides claiming the honorable side of protecting rights. Both senators switched to favor business and the union card-check legislation died, although management groups are still running anti-union ads in Arkansas to be sure that the labor bill stays buried.
Now, far more is at stake with health-care reform. Because she is a swing member of the Senate Finance Committee, one of five congressional committees working to carry out President Obama’s promise of universal health insurance, Lincoln is at the center of the national struggle. The insurance industry and medical-provider groups are keeping up a media blitz to pressure Lincoln and Pryor to oppose a public option to private health insurance plans. Though on a far smaller scale, the interests supporting a public, or government-sponsored, plan are trying to generate public pressure on the two senators.
So where will they come down? Their public comments have been generally unremarkable, leaving every side with some expectations of getting the senators’ support. We have found ourselves increasingly optimistic that Sen. Lincoln will support a package of reforms that will guarantee medical coverage for everyone in this health-poor state.
She said that was her expectation: that every Arkansan and every American will have access to affordable health insurance. Her biggest supporters, the Walmart company and family, came out recently for the president’s idea of mandatory employer participation, and she said that helped and that she would favor it, too.
An op-ed article signed by Lincoln that appeared in Arkansas newspapers last week said she favored having either a government plan alongside private insurance plans or else nonprofit cooperatives that would offer competing plans to the insurance industry’s. She had seemed earlier to lean toward the cooperatives, but last week she expressed no preference between the government and nonprofit option. That is at least hopeful.
If she is deliberate and objective, she will conclude that the two do not offer the same prospect of healthy competition. The idea of the government plan is that it would compete with the insurance oligopoly and drive down prices. That is why both the handful of insurers and some medical interests oppose it. They fear that the government health plans would maintain the low hospital and physician rates paid now by Medicare. If they were to compete for individual and group coverage with the low-cost government plan, the companies would have to lower reimbursement rates, trim their profits or find big administrative savings. The ballooning cost of health insurance would level off (the cost of insurance in Arkansas rose 66 percent between 2001 and 2007, more than five times the rate of income increase).
The question is, would an amalgam of cooperatives that could spring up around the country under the other scenario offer rates low enough that the low-to-middle-income insured in Arkansas could afford it? Without the bargaining power of a central public plan, could they force lower expenses? Could they compete at all?
History is not encouraging. The federal Farm Security Administration encouraged health cooperatives in the 1930s and 1940s but, small and under-capitalized, they fizzled. Blue Cross and Blue Shield, now one of the giants in the industry, began as community nonprofit plans. Now mutual companies, they are indistinguishable from the other commercial carriers. Some of the most profitable and high-cost companies in the country are former Blue plans.
Sen. Kent Conrad (D-N.D), the leading exponent of cooperatives, has suggested an alternative that might work, though not as well as a government plan. Instead of a hodgepodge of state and community coops, it would be a single national cooperative, independent of the government but chartered by Congress and operating under some congressional rules — something like the social-insurance funds in Germany and some other western European countries.
Conceivably, it might be little different from a government-sponsored plan modeled on Medicare, but it would give Lincoln and Pryor some ideological cover.
