Smith: Schumer’s Health-Care Crossroads

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No public issue passes through New York or Washington without attention from Chuck Schumer. High, low, consequential, or esoteric, our senior senator is on the scene: There he is, crying as he introduces Supreme Court nominee Sonia Sotomayor before her confirmation hearings. Watch him bounding into action to stop a sneaky concealed-weapon bill from becoming law. And pushing to extend the "Cash for Clunkers" program while warning of scams. And nudging along the refinancing of Starrett City. And decrying the air-traffic gridlock at the city's airports. And unveiling a plan to give every child born in the United States a $500 savings account as soon as he or she breathes air. And leading the charge against "flash trading" on Wall Street. And choking off the oxygen to any Democrat who'd dare challenge Kirsten Gillibrand in a primary. And sounding the alarm about "distracted driving." All pretty much at the same time.

Schumer is so energetic — and so good at self-promotion — that the breadth of his activity often makes it difficult to judge the actual importance of his role in any single issue. But in the biggest domestic-policy debate of the moment — heck, probably of this decade and the next several — Schumer is playing a pivotal part. As with most things involved in the fight over health-care reform, however, Schumer's role is even more complicated than it first appears. And when Congress returns from its current recess in September, the senator may face one of the most difficult political crossroads of his career.

Schumer is not one of the Gang of Six, the bi-partisan group of Senate Finance Committee members, led by Montana Democrat Max Baucus, that has been at the center of health-care negotiations. Yet Schumer has played a crucial role in framing the group's discussion. This spring Baucus handed Schumer one of the most controversial tasks of the entire health-care debate, developing a "public plan" — a government-run health-insurance option — that could cover millions of uninsured Americans while not further inflaming the guv'mint-hating "socialized medicine" scare-tactic right. The nuts and bolts of the plan Schumer crafted are reasonable enough; his proposal that the public option pay for itself, instead of being government subsidized, is an especially canny appeal to conservatives.

So far, it doesn't seem to have worked: Senator Charles Grassley, the top Republican on the Senate Finance Committee, branded Schumer's proposal "obnoxious," and Baucus's group appears to have ditched the public option (the House health-care bills, and competing Senate bills, do contain versions of a public option that are clearly influenced by Schumer's work). Yet the greater significance of Schumer's involvement is that it provides political cover on the left: The theory is that Schumer has enough credibility with the progressive wing to sell the idea that he tried his best and a centrist plan is the best the Senate can do.

Schumer often appears to be a primal force unto himself. But his moves in the health-care game have been carefully strategized with the Obama White House, particularly Schumer's close ally from the 2006 electoral wars, Rahm Emanuel. So Schumer's tough talk last week about Democrats being prepared to pass a health-care bill without any Republican support was seen as delivering a message from Obama at a time when the president was facing increasing criticism for giving ground to the insurance industry. "Schumer floating it was a signal to the left, which is worried about the bill being watered down," says Bill Pierce, a former Bush administration official and now a Washington health-care strategist. "The Democratic leadership is saying, 'We won't knuckle under.' And it says to the Republicans that the Democrats are serious about doing it by themselves."

Schumer, having masterminded a Senate Democratic majority, is a large reason why that route is even possible. But going it alone would have important policy ramifications; because of Senate procedural rules, a Democrats-only health-care bill would probably sacrifice, for instance, the coverage of preexisting medical conditions. The one-party approach would also have political fallout: By dividing Congress into intransigent partisan camps yet again, it might damage Obama's future legislative agenda.

Schumer understands all this, of course. He also knows that he's on record unequivocally promising to deliver a Senate health-care package that includes a public option. And he's been one of the strongest proponents of a public option during internal Senate discussions. Which may put Schumer in a tight bind next month. "Senator Schumer has provided real leadership," says Richard Kirsch, the head of Health Care for America Now, a liberal lobbying group. "He's been good about saying he'll stick by his principles. The question is whether the president sticks by those principles as well." Obama says he's strongly in favor of a public option. But the president could be forced to choose between a greatly compromised plan that doesn't include a true public option yet can muster a minor degree of Republican support, and a Democrats-only bill that carries large political risks.

In designing his version of a public plan, Schumer consulted with Len Nichols, director of the health-policy program at the New American Foundation, a Washington think tank. Despite the Republican onslaught, Nichols remains cautiously optimistic that a middle ground can be found, with Schumer leading the way. "I can see a bill where the public plan is an option for certain states and markets, or a fallback that's triggered if coverage conditions aren't met by the private plans," Nichols says. "That would be far superior to doing nothing."

In 1994 it was Daniel Patrick Moynihan who delivered the unpleasant news that a Democratic president's health-care proposal wouldn't fly in Congress. Moynihan, for all his intellectual gifts and his reputation as a flighty academic, was a tough-minded legislative realist; it was the occupants of the White House at the time, especially Hillary Clinton, who were delusional dreamers. The role reversal isn't perfect, and the larger political dynamics quite different, but now it's the White House that's pragmatic and calculating and the New York senior senator who is playing the staunch health-care idealist. Schumer's real role, of course, is more nuanced, and he's never been the all-or-nothing type. If anyone can keep a meaningful public option in the mix, it will be Schumer. Otherwise, he'll be confronted with a choice between defying Obama or signing on to diluted health-care legislation simply to be able to say the Democrats acted. And that won't do much good for anyone's health — physical, emotional, or political.