The reform of health insurance is currently paralyzing America: it sharply divides the U.S. population, it consumes a lot of political credit to Barack Obama, who sees his leadership questioned, and it provides a new impetus to Republicans until then barely visible on the political scene. From Europe, we consider especially the images of these American citizens showing signs in hand against the hand-up "socialist-Marxist" the U.S. government. We wonder, puzzled about what motivates Americans to fight hard against any reform that would both improve access to care and lower costs of an expensive medicine. But the debate is elsewhere. Here are some keys to understanding why the opposition to this reform is so strong, why the process is so complicated and what are the solutions to overcome the impasse. Different elements specific to the values and foundations of the United States are parasitizing the debate on health insurance.
On the one hand, Americans are afraid that their reform removes a fundamental right: the power to choose. The Republican propaganda to believe that the government require every citizen the doctor that he should see that fly in a country where freedom of choice is at the heart of its foundations. More generally, many Americans - especially the conservatives, who are, do not forget, still very numerous (1) - think the government did not decide whether an individual must be uninsured or .
The Americans also fear that increasing taxes and the federal deficit worse. Using the argument of the 46 million uninsured Americans to defend his plan, Barack Obama has raised many concerns about the cost of this reform. If he had started by putting forward the objective of cost reduction (which may ultimately make health care more affordable), the project would have generated less resistance.
The fear that the government acquires too much power also has the disadvantage of the reform. In general, Americans are reluctant to the idea of a law that would give the federal government the power to regulate an issue related to privacy.
It should be noted that the opposition comes not only from Republican ranks. Democrats are also opposed to this reform, particularly in southern states, more conservative and in favor of fiscal discipline (called Blue Dog Democrats). The elected Democrats in the South have indeed a conservative electorate and can not pass laws "too liberal" or risk losing their seats in the forthcoming elections. Having already supported a liberal reform, the energy (cap-and-trade), they probably do not support the Health Insurance.
Opposition to the reform of health insurance is very strong in the Republican Party and the South, where racial issues are still very pregnant. This can lead to wonder, as indeed is Jimmy Carter, if the arguments of opponents of this reform are primarily political or ideological.
During the election campaign, Barack Obama said he wanted to pursue an ambitious reform of health insurance, among other things, establish a mandatory public option. But it is the Congress that it is now drafting a law that will both please the voters and the president.
Each chamber of Congress has in its committees in charge of studying specific reform proposals and amend if necessary before the plenary vote. In the U.S., these committees are particularly powerful.
For a reform as complex as health insurance, several committees were mobilized three committees of the House of Representatives (Energy & Commerce, Ways and Means and Education and Labor) have begun to develop three different versions in spring 2009. On July 14, 2009, they proposed a joint text, subject to amendments. The text must be approved by a simple majority.
In the Senate, two committees are in charge of reform. The first (Health, Education, Labor and Pensions, more known as HELP) has announced its version of the law July 15, 2009. The second (Senate Finance Committee) has proposed a more conservative version September 16, 2009 (the Baucus Bill) version currently under discussion. The debate could last as more than 500 amendments were tabled. Both versions of the Senate must then merge into a final text that the Senators should approve by a simple majority.
The final text of the House of Representatives and the Senate's final version will then be merged by a bicameral committee on a bill, which must be approved by all members of each chamber and then by the President.
It is understood, it is a race against time that is now underway in Congress since the President would see the law adopted before the end of the year and that the Republicans will do everything to delay the vote. One of the rules governing the work of parliamentarians would allow to close the debate quickly and move on. In the House of Representatives, he need to do is get a simple majority. In the Senate, however, must obtain the majority of 3 / 5, the famous 60 votes that the Democrats are desperate to get to prevent the debate drags on. It is therefore to invoke "cloture" to end the filibuster, the filibuster by the opposition used to delay a vote on a law.
The majority in the House of Representatives can be obtained with the support of Democrats Blue Dogs, who hold 45 seats (2). In the Senate, besides the weight of the Blue Dogs, the seat of Ted Kennedy has still not been replaced, thus denying the Democrats the 60 votes. Without those 60 votes, Republicans may continue to prolong the debate for a long time. The time is for them because it allows them to consolidate the opposition to reform, to disrupt Barack Obama and to challenge the parliamentarians will have to appear before voters in fall 2010.
Ultimately, October 10th Congress opens next procedure "budget reconciliation" (budget reconciliation process): this date, the rule of 3 / 5 (and thus the filibuster) is suspended in the Senate so that all laws that impact on the budget (acts involving or affecting federal spending to taxes) are passed in time before the budget vote (in this case, the 2010 budget). With this procedure, the number of amendments and limited debate ended after 20 hours. For Democrats, this would be a way out, certainly not glorious, but practical.However, this procedure is not without risk. It could raise one hand the ire of opponents of reform, private discussion. On the other hand, if the reform goes through this procedure, it would have to be revotée each year (the budget). One can understand the opponents of reform do their utmost to ensure that the health insurance plan is not renewed next year. In addition, it will not be a radical reform, because enough not to vote again for it to clear.
The dilemma is as great to spend the Democrats will have to make some concessions, including the famous "public option". On 29 September the Senate Finance Commitee moreover rejected amendments to include an option in public law, so that the project supports the greatest possible senators and quickly put an end to the filibuster (3). But without this public option, the reform of health insurance Obama is not revolutionary. The most progressive aspects of the reform are likely to disappear for it to be passed by Congress.
The question is whether Barack Obama, resolutely decided to include a "public option" in its reform, will agree to sign a bill whose ambitions would be downgraded?
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