Why sickly US health bill affects us all

Republican resentment bodes ill for yet-to-be-passed bills

So the picture on Capitol Hill may now be one of grinning Democrat faces -- but for how much longer? Early today, health-care reforms backed by President Barack Obama finally scraped past the crucial Senate hurdle, with the Democrats getting the required 60 votes to move the bill to a final vote by Christmas Eve.

Yet this Democratic victory has bred deep resentment in the Republican caucus. Reports from Washington suggest that a new era of partisanship is about to begin, boding ill for yet-to-be-passed bills still tied up in the Senate.

The key concern is that Republicans will choose to play politics, causing domestic intransigence to weigh down on globally important issues such as climate change and nuclear weapons proliferation.

Climate change legislation, which Senate Democratic leaders aim to bring to the floor by next spring, has been hotly opposed by Republican senators, particularly those from the manufacturing states. The failure of the bill to pass through the Senate before the recently ended Copenhagen summit was blamed as one of the reasons for the world's subsequent inability to agree on a legally binding treaty, demonstrating how America's domestic problems have impeded global co-operation.

Similarly, Obama wants the Senate to ratify the Comprehensive Test Ban Treaty, a legally binding agreement that calls for a world halt to nuclear weapons testing which the US Senate declined to ratify in 1999. To date, the treaty has been signed by 182 countries, but has yet to come into force because the US and eight other countries have yet to give it their approval.

Both bills require a 60-40 majority to pass, making a show of bipartisanship all but crucial for any hoped-for success: with exactly 60 Democratic senators there is no room for manoeuvre. And, remember, Obama's stated goal was to achieve a bipartisan health bill -- a forgotten hope.

Republicans are convinced that the Democrats are heading towards an "historic mistake" and intend to force a series of six procedural showdowns to keep Senate in session right through Christmas Eve -- a tactic designed to drag the final vote out until after the Democrats' self-imposed deadline. If successful, this would further delay attempts to work out a compromise between the House's and the Senate's health-care legislation.

Moreover, the Democrats' hard-fought win still hangs in the balance -- the absence of a single member of the Democratic caucus could derail the bill's progress.

"What the American people should pray is that somebody can't make the vote," Senator Tom Coburn of Oklahoma, a leading Republican opponent of the health bill, was quoted as saying.

The Senate bill, as it now stands, will significantly transform the US health-care system, mandating almost all Americans to buy insurance, with those from lower-income groups receiving subsidies to do so. It would mean 94 per cent of Americans under the age of 65 would have medical coverage by 2019.

But compromises had to be made in order to win the necessary votes.

The option of a new government-run insurance plan to compete with private insurers was dropped, while support had to be given to revised language on abortion in order to win the crucial 60th vote from Senator Ben Nelson from Nebraska -- one of the most conservative Democrats. The bill now says that states can opt out of insurance plans that cover abortions, and state "insurance exchanges" will have to offer at least one plan that does not fund abortions.

Nelson's support for the bill was also given on condition that the federal government will permanently fund Nebraska's bill for Medicaid, the insurance plan for the poor.

Such wrangling for votes has attracted fierce criticism that the concessions made to Nebraska are akin to bribery and corruption. Senator John Cornyn, a Texas Republican, described the effort to get the 60 votes as "basically a pay-to-play approach . . . and it's just repulsive".

However, this does not mean that the haggling is over. The bill will have to be merged with the House's version, which still restrains the government option and places stricter limits on abortion funding, before going back to both houses for another vote.

 

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Andy Burnham and Sadiq Khan are both slippery self-mythologisers – so why do we rate one more than the other?

Their obsessions with their childhoods have both become punchlines; but one of these jokes, it feels to me, is told with a lot more affection than the other.

Andy Burnham is a man whose policies and opinions seem to owe more to political expediency than they do to belief. He bangs on to the point of tedium about his own class, background and interests. As a result he’s widely seen as an unprincipled flip-flopper.

Sadiq Khan is a man whose policies and opinions seem to owe more to political expediency than they do to belief. He bangs on to the point of tedium about his own class, background and interests. As a result he’s the hugely popular mayor of London, the voice of those who’d be proud to think of themselves as the metropolitan liberal elite, and is even talked of as a possible future leader of the Labour party.

Oh, and also they were both born in 1970. So that’s a thing they have in common, too.

Why it is this approach to politics should have worked so much better for the mayor of London than the would-be mayor of Manchester is something I’ve been trying to work out for a while. There are definite parallels between Burnham’s attempts to present himself as a normal northern bloke who likes normal things like football, and Sadiq’s endless reminders that he’s a sarf London geezer whose dad drove a bus. They’ve both become punchlines; but one of these jokes, it feels to me, is told with a lot more affection than the other.

And yes, Burnham apparent tendency to switch sides, on everything from NHS privatisation to the 2015 welfare vote to the leadership of Jeremy Corbyn, has given him a reputation for slipperiness. But Sadiq’s core campaign pledge was to freeze London transport fares; everyone said it was nonsense, and true to form it was, and you’d be hard pressed to find an observer who thought this an atypical lapse on the mayor’s part. (Khan, too, has switched sides on the matter of Jeremy Corbyn.)

 And yet, he seems to get away with this, in a way that Burnham doesn’t. His low-level duplicity is factored in, and it’s hard to judge him for it because, well, it’s just what he’s like, isn’t it? For a long time, the Tory leadership’s line on London’s last mayor was “Boris is Boris”, meaning, look, we don’t trust him either, but what you gonna do? Well: Sadiq is Sadiq.

Even the names we refer to them by suggest that one of these two guys is viewed very differently from the other. I’ve instinctively slipped into referring to the mayor of London by his first name: he’s always Sadiq, not Khan, just as his predecessors were Boris and Ken. But, despite Eoin Clarke’s brief attempt to promote his 2015 leadership campaign with a twitter feed called “Labour Andy”, Burnham is still Burnham: formal, not familiar. 

I’ve a few theories to explain all this, though I’ve no idea which is correct. For a while I’ve assumed it’s about sincerity. When Sadiq Khan mentions his dad’s bus for the 257th time in a day, he does it with a wink to the audience, making a crack about the fact he won’t stop going on about it. That way, the message gets through to the punters at home who are only half listening, but the bored lobby hacks who’ve heard this routine two dozen times before feel they’re in the joke.

Burnham, it seems to me, lacks this lightness of touch: when he won’t stop banging on about the fact he grew up in the north, it feels uncomfortably like he means it. And to take yourself seriously in politics is sometimes to invite others to make jokes at your expense.

Then again, perhaps the problem is that Burnham isn’t quite sincere enough. Sadiq Khan genuinely is the son of a bus-driving immigrant: he may keep going on about it, but it is at least true. Burnham’s “just a northern lad” narrative is true, too, but excludes some crucial facts: that he went to Cambridge, and was working in Parliament aged 24. Perhaps that shouldn’t change how we interpret his story; but I fear, nonetheless, it does.

Maybe that’s not it, though: maybe I’m just another London media snob. Because Burnham did grow up at the disadvantaged end of the country, a region where, for too many people, chasing opportunities means leaving. The idea London is a city where the son of a bus driver can become mayor flatters our metropolitan self-image; the idea that a northerner who wants to build a career in politics has to head south at the earliest opportunity does the opposite. 

So if we roll our eyes when Burnham talks about the north, perhaps that reflects badly on us, not him: the opposite of northern chippiness is southern snobbery.

There’s one last possibility for why we may rate Sadiq Khan more highly than Andy Burnham: Sadiq Khan won. We can titter a little at the jokes and the fibs but he is, nonetheless, mayor of London. Andy Burnham is just the bloke who lost two Labour leadership campaigns.

At least – for now. In six weeks time, he’s highly likely to the first mayor of Greater Manchester. Slipperiness is not the worst quality in a mayor; and so much of the job will be about banging the drum for the city, and the region, that Burnham’s tendency to wear his northernness on his sleeve will be a positive boon.

Sadiq Khan’s stature has grown because the fact he became London’s mayor seems to say something, about the kind of city London is and the kind we want it to be. Perhaps, after May, Andy Burnham can do the same for the north – and the north can do the same for Andy Burnham.

Jonn Elledge edits the New Statesman's sister site CityMetric, and writes for the NS about subjects including politics, history and Daniel Hannan. You can find him on Twitter or Facebook.