The current attempt to steamroller a drastic healthcare reform bill through Congress has created a rift between the Obama-Pelosi (OP) Democrats and what might be called the "blue-chip" (BC) faction---the moderate mainstream Democrats whose alliance, or at least acquiescence, is probably essential for the passage of any legislation. These two factions have very different ideas of what "healthcare reform" should mean.
It is difficult to pin down exactly what BCs want. Caught in the crossfire between the Chicago-style strong-arming of the White House and the anger of the electorate, they have become evasive . But it is likely that most would accept, as a minimum:
B1. Available healthcare insurance for all citizens who want it, with most BCs being willing to exclude illegal aliens.
B2. A reasonable level of healthcare with no rationing or curtailment for the elderly or chronically ill.
B3. The deletion of a "public option" to compete with private insurers, although there is considerable divergence of opinion on this point.
B4. Avoidance of controversial issues such as abortion, medical rationing, and assisted suicide.
B5. A convincing estimate of a total cost that will not aggravate our huge deficit or endanger the economy.
In contrast, the OP agenda, as set forth in House Bill 3200 and diagrammed by the staff of Rep. Kevin Brady, is vastly more grandiose . It includes:
O1. Mandatory healthcare insurance for everyone, including illegal aliens.
O4. Inclusion of a government-run public option and a delayed-action "poison pill" calculated to force private insurers out of business. In short, the ObamaCare plan would create an elaborate political machine that would give the federal government total control of a bureaucratic healthcare empire so far-reaching and destructive of existing private institutions that, like a deeply rooted and metastasized cancer, once established, it would be impossible to remove. The czar of this empire, the Health Care Administration Commissioner, answerable only to the President, would set benefit rates, select and regulate participating insurance companies, and administer a rival Public Health Plan that Obama and his colleagues have previously admitted would be merely a stepping stone to a federal single payer system. Diagram of HR 3200 as analyzed by the staff of Rep. Kevin Brady
BC Democrats are justifiably alarmed by many of these provisions. Moreover, with an apprehensive eye on the 2010 elections, they are concerned about the vigorous voter resistance they have encountered in town meetings. But, since they are still committed to universal healthcare insurance and will need party support for next year's election campaigns, they may be arm-twisted or bludgeoned into acquiescence to the passage of HR 3200.
But what have the Republicans proposed? A few, such as Kevin Brady, have acknowledged the need for reform and published detailed proposals. But most Republicans, although dissenting about questionable aspects of HR 3200, have either made no counterproposals of their own (thereby implying that they regard the status quo is acceptable) or have introduced alternative legislation, such as the Patients' Choice Act, that does not meet BC expectations and has no chance of passage through a Democratic congress.
This is political suicide. A majority of Democrats do want some sort of healthcare reform, almost all of the Democratic candidates campaigned for it, the Democrats control both houses of Congress and virtually all its committees---and so, like it or not, we will almost certainly have some form of healthcare reform measure enacted this year.
Therefore, it is urgently necessary that Republican leaders unite in a counterproposal that will gain widespread BC acceptance. By way of example, I hereby suggest a provisional plan based on:
(a) modifying an existing bill, e.g. using the HR 3200 organizational plan as a starting point,
(b) paring down the ObamaCare empire, so that it conforms to the basic aims of the BC Democrats while eliminating anything that is not essential to those aims, and
(c) proceeding cautiously and economically by making every change potentially reversible and by using existing agencies and institutions as much as possible.
These guidelines lead to deletions and changes in the current structure of HR 3200 such as the following:
- There is no need for a Health Choices Administration or HCA commissioner. In fact, these duties would conflict with those of state agencies and might even be a violation of the tenth amendment. Instead, the federal government should begin by accepting any insurance company and/or professional certification that is already accepted by a state agency. This might be facilitated, without excessive federal regulation, by establishing interstate health insurance as proposed last year by McCain and more recently by several members of Congress.
- There is no need for a federal one-size-fits-all standard for healthcare insurance. In fact, as Robert Veach has pointed out in Patient, Heal Thyself, this would be a gross violation of the bioethical right of a patient to chose an insurance plan that fits his own set of value judgments.
- There is no need for a "Public Health Plan" insurance organization. Instead, the insurance of otherwise uninsurable families and individuals, such as people thrown out of work, would be assigned to existing private insurers by a system similar to the assigned-risk methods currently used for auto insurance. This would be the primary function of the so-called Health Insurance Exchange and could be handled by the proposed "Reinsurance Program" office .
- There is no need to create a National Health Service Corps or Public Health Workforce Corps. There are numerous private volunteer and faith-based agencies that already carry out the activities proposed for these 'corpses' and that have frequently demonstrated their superiority to federal agencies in effectiveness and efficiency. Such organizations should be encouraged and honored, instead of being shoved aside.
- There is no urgent need for a Bureau of Health Information or for the related IT, civil rights, and minority offices. Other federal and state agencies currently carry out these functions and can continue to do so. Similarly, there is no urgent need for any of the special offices colored yellow in the Brady diagram. Offices and agencies of this kind could be added later, when and if they prove to be necessary.
- There is an urgent need for assurance of cost reduction. Therefore the Obamacare machinery must be reduced by at least 50%.
When these deletions are made, the Brady diagram begins to look more reasonable, while still fulfilling the basic requirements of most BC Democrats.
Proposals like this, which reduce healthcare reform to its essentials and make maximum use of existing federal, state, and private agencies and institutions, would greatly reduce the proposed levels of administration costs and the inevitable tax burden. Moreover, in sharp contrast to the Obamacare empire, such a system would be emendable and would be ultimately answerable to Congress and the American people rather than solely to the POTUS.
I therefore hope that Republican congressional leaders will, in the few weeks remaining, draft, publicize, and introduce a counterproposal of this type and implement it by major amendments to pending bills. Otherwise, it is probable that some virulent form of HR 3200 will be rammed down our throats (or some other orifice) and that the prognosis of our healthcare system will change from "serious" to "critical" while the costs continues to soar . When this happens, Doctor Obama, like any other quack, will simply yell for more turpentine.
 The "blue chip" faction may be substantially larger than the 52 member Blue Dog Coalition of House members that have vocally criticized HR 3200. Some, caught between OP coercion and voter rebellion, are "closet BCs", as evidenced by the disparity between what they proclaim on their websites and what they say to voters at town meetings.  HR 3200 is an excellent example of Hilaire Belloc's observation that:
...three characters appear which are the concomitants of all revolutions, and the right management of which alone can prevent catastrophe. The first character is [that] change of every kind and every degree is proposed simultaneously, from reforms which are manifestly just and necessary---being reversions to the right order of things---to innovations which are criminal and mad.
 Even the advocates of Obamacare admit that:
We're not sure it's even possible to nail down a firm answer to the cost question. The president's health-care plan is a work in progress, relying on a host of long-term projections...Can Obama and the Democrats really squeeze $70 billion of waste out of Medicare? The Congressional Budget Office, looking at earlier drafts of health-care reform, has expressed doubts.
These doubts are exacerbated by the "now or never, all or nothing, take it or lose it forever" urging of the POTUS, which has a strong odor of con-man hustle.  As part of his retreat strategy, Obama has proposed replacing the public option with co-op insurance organizations. This might be an acceptable compromise, but looks suspiciously like one of the Trojan horses for which the Obama administration is so justly famous.
 All of the healthcare reforms discussed to date are concerned primarily with insurance, which is only one of the factors driving up healthcare costs. No plan, least of all HR 3200, has yet directly addressed the basic issue that is the root of all of our concerns about healthcare -- the high and ever-spiraling costs of physicians' fees, clinical tests, medicines, hospitalization, and medical schools. Alleviation of this burden would require basic but not infeasible changes in our healthcare system that are not at all addressed in current legislation. This issue will be discussed elsewhere.