John Nichols and Terry O’Neill on Health Care Reform

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Bill Moyers takes a closer look at the newly signed health bill and explores the future of health care reform with THE NATION’s John Nichols and National Organization for Women president Terry O’Neill. 


BILL MOYERS: Welcome to the JOURNAL. There was justification for those high-fives and victory signs at the White House this week. Passage of the health care reform bill was a big political win for a president and party, who, with midterm elections eight months away, desperately needed a few points on the scoreboard.

But the road to success is littered with casualties, most of them Obama’s progressive allies. Among them, the women who worked so hard for his election. After all the White House hoopla was over and the lights and cameras were gone, the president quietly signed an executive order continuing a ban on federal funding for abortions, part of the deal he made with pro-life Democrats to get their votes. Terry O’Neill, president of the National Organization for Women, NOW, was outraged. She said “feminist, progressive principles are in direct conflict with many of the compromises built into and tacked onto this legislation.”

Terry O’Neill is with me now. An attorney, law professor and social justice activist, she became president of NOW last June.

Joining us is John Nichols, author, political journalist and Washington correspondent of The Nation magazine. He wrote this article on The Nation’s blog headlined, “Now That Obama’s Signed It, Let’s Reform the Reform.”

Both of them are progressives who prescribed a much stronger dose of health care reform than we got. So my question to them is, “Where do we go from here?” John, Terry, welcome to the Journal…

TERRY O’NEILL: Thank you.

BILL MOYERS: This is the most sweeping piece of legislation passed since Medicare in 1965. What do you think of it?

TERRY O’NEILL: Well, I– that’s exactly right. It is the first time in this country’s history that we have had comprehensive health care legislation. And it is painful to me that women’s health has been singled out. The first time that we do this as a country, we single out women to be deprived of ordinary health care that they need. And I’m talking about the sweeping anti-abortion provision there.

Forty percent of women have had or will have an abortion in their lifetime. It is a common medical procedure. It needs to be safe. It needs to be fully and equally accessible to all women. And what has been enshrined in this law is not so much the principle about whether federal dollars go to pay for abortion, what is really enshrined in this law is that ideology can trump health care needs of an entire class of people in this country.

BILL MOYERS: That, of course, is what you don’t like about the bill.


BILL MOYERS: But is there– are there some things in it that you admire? Or that you’re glad we have now?

TERRY O’NEILL: Sure. We like the preventive measures. Senator Barbara Mikulski put in strengthening language that requires insurance companies to cover mammograms and pap tests and other types of screening. And that’s great. We like the community-based health care centers. We like funding, more funding for low-income, uninsured and under-insured people.

BILL MOYERS: What do you like about it?

JOHN NICHOLS: There’s things I love in this bill. Senator Bernie Sanders from Vermont, strong supporter of single payer Medicare for All, put in some incredible measures that extend and protect public health clinics, make them stronger, allow for a lot more funding to go there. These are going to be our first line in a whole bunch of public health. They’re great.

Senator Sanders also put in a provision that in an incredible fight that will eventually allow states to experiment with something closer to a Medicare for All single payer type model. Unfortunately, you can’t do it for the better part of ten years. So, there’s a lot of good elements in this bill. That’s not the problem. This is a bill that is at odds with itself.

We say this is a bill that promises health care for all. And yet, there are tens of millions of Americans who will not get health care as a result of this bill. They acknowledge leaving the better part of 12 to 16 million Americans out. We say this is a bill that, or it is said, this is a bill that’s going to take on the big insurance companies. And yet, it requires middle class Americans to buy insurance from the big insurance companies.

BILL MOYERS: Under penalty.

JOHN NICHOLS: Under penalty. We say this is a bill that recognizes science and reality, public health concerns. And yet, as my colleague here points out, we leave over half the population out in a basic health care requirement, a basic health care need. And we also deny public health. Because this bill discriminates against immigrants who live in this country but have not yet achieved citizenship.

BILL MOYERS: David Leonhardt in “The New York Times” says this is “the federal government’s biggest attack on economic inequality” in over 30 years. That should please both of you as progressives, right?

TERRY O’NEILL: Yes. Yes, it does. And I think what’s best about this law, really, is the concept of it. The actual provisions of it are not good. But the concept that in fact the federal government has the largest role to play.

So that’s a big deal. And there are parts of the law that really do go to providing more and better care for people who have not had access. Uninsured and under-insured. I disagree in a sense that there are provisions of the law that sock people, particularly women, who can least afford it. So, for example, the age rating, right? The insurance companies are permitted specifically under the law to charge three times the premiums to older people.

They haven’t said what age, but presumably it’d be something like from 40 to 64. And at 65, you go on Medicare. But from 40 to 64, your premium could be triple that of a younger adult. Who does this hit? It hits middle-aged women, whose entire careers have been affected by systematic wage discrimination.

BILL MOYERS: Why do you think President Obama decided so early last year, before all of this actually began to leave the for-profit insurance industry alone.

JOHN NICHOLS: I think he didn’t want to fight that fight. Because that is the great struggle. And I don’t mean to say I’m prescient or anything like that. But I was there at the inaugural, and I listened to that inaugural address, which I thought, frankly thought was a pretty weak address. The address he should have given at the start was, you know, this country has been in chains. This country has been prevented from making real progress for generations, because of immense corporate power driven into our politics through our elections and through lobbying. And it is my intention to break those chains, and the place that I will begin to break them is in the health care fight.

If he had done that, if he had said from the start, we would have had a very different health care debate. It would have been a better health care debate. He would have been accused of being a socialist. He would have been accused of, you know, trying to have a government takeover, all these things. Well, it all happened anyway. And so, bottom line is he miscalculated.

BILL MOYERS: What if you’re both wrong about Obama being a progressive? I mean, the–

JOHN NICHOLS: I’m not sure he is.

BILL MOYERS: –the liberal economist and former Clinton Secretary of Labor, Robert Reich wrote this week that “Obama’s health care bill is a very conservative piece of legislation building on a Republican rather than a New Deal foundation.” And he’s referring to Republican Presidents Nixon and Eisenhower who advocated a market for health care based on private insurers and employers. And that’s what Obama is doing.

JOHN NICHOLS: President Obama abandoned the logical progressive responses to a health care crisis at the start. It was never the public option. The public option itself was a compromise. The fact of the matter is Congressman Pete Stark laid out a long time ago–

BILL MOYERS: California Democrat.

JOHN NICHOLS: Great California Democrat. Who everybody picks on for being a little too tough. Well, he said it very bluntly a long time ago. We’ve got a great single payer program in America. It’s called Medicare. We should open it up to everybody and have a Medicare for All program. If the President had said that from the start, you wouldn’t have had anybody at the town meetings saying, “I’m against health care reform, because it might take away my Medicare.”

BILL MOYERS: But since the President has left the for-profit motive intact, haven’t we locked in the impossibility of moving toward a single payer universal health care. Given the new power that has been invested in the for-profit industry.

TERRY O’NEILL: Sure. 32 million new customers for the insurance industry required to be customers of the for-profit insurance industry with very few actual cost controls, because there’s no public option. Because you can’t buy into Medicare if you want it. Okay? We have a Supreme Court that has just overturned 100 years of regulation of federal election laws. And you have this empowered corporate insurance industry sort of unchained by the Supreme Court. And it really is going to be an uphill battle.

BILL MOYERS: So, sum up for me, Terry, as succinctly as you can, the impact of this legislation as you see it on women.

TERRY O’NEILL: All right. We’ve been told over and over again that gender rating is gone, but it’s not. Employers with more than 100 employees who buy into a plan on an exchange, the insurance companies will be permitted to charge higher premiums up to, up to 50 percent higher for women than for men, just because they’re women.

Age rating. We talked about that before. The triple premiums being paid by older people has a disproportionate impact on women. So these are the issues that we see that are problematic.

BILL MOYERS: What did you think when you heard about the President’s eleventh hour decision to sign the executive order? It was quite a private affair, as you know. The White House released only one photo of the actual signing. It’s only two pages long this executive order. But some people are suggesting that it may be the most important signature Obama will put on a bill this year, because it assured passage of health care legislation by gaining a handful of critical pro-life Democrats. What did you think when you heard about that?

TERRY O’NEILL: Well, we put out a statement that said we were incensed. And I stand by that statement. Look–

BILL MOYERS: Have you read the executive order?

TERRY O’NEILL: I did. I read the executive order. And it does two things. First of all, it says that it’s necessary to enforce the principle that tax dollars should not be used to pay for abortion. Number one, it suggests– this language suggests that the Hyde Amendment is settled law. I’ve been hearing that during the entire health care debate. It’s not so. The Hyde Amendment is not settled law. Not until we put it into this law. As originally passed, the Amendment simply said that Medicaid dollars could not be used to fund abortions for low income women.

The Hyde Amendment was passed in 1976. It was an illegitimate tack-on to a must-pass appropriations measure. Every single year since then it has been tacked on to an appropriations measure. And it changes every single year because of that. Some years it’s more onerous to low income women. Some years it’s less onerous to low income women.

What this law says goes way beyond Hyde, because it says we are enshrining a principle that no federal tax dollars, no subsidies, not direct, no indirect, no funding whatsoever for women’s abortions.

This law requires anyone who buys into a plan that happens to cover abortion care would have to write two checks. One check for the abortion care part, and one check for everything else. Okay? It’s bizarre. And it does nothing to actually segregate funds. All it does is segregate this particular health care service.

BILL MOYERS: But there are some contrary opinions to that. Michael Shear writing in the “The Washington Post” says it does little more than restate the existing ban on public financing of abortion. The old Hyde Amendment. And the White House– remember, the White House Press Secretary says, we reiterated the status quo. And we’re comfortable reiterating that status quo now.

JOHN NICHOLS: With all due respect, it’s the job of the White House Press Secretary to say that.

BILL MOYERS: Tell me about it.

JOHN NICHOLS: Right? And I have great respect for Mr. Shear. I assume he’s read the executive order as my friend here has.

BILL MOYERS: He counted the words.

JOHN NICHOLS: I’m going to disagree with him. But it reinforced the notion that getting to this basic principle, we’re going to go through a smorgasbord. Right? We can walk down the smorgasbord and we say, “Well, yes, of course, it’s moral and decent to make sure that every American has health care. But I’m not going to take the plate that’s for women. Or I’m not going to take the one for immigrants. I’m not going to take the one for public health. I’m not going to–” This is the wrong way to frame a discussion.

Those who are opposed– my conservative friends who are opposed to health care reform, who don’t believe it’s a right. They should absolutely say, “I’m opposed to it. I don’t like government. I don’t think government should do this.” But people who actually believe in health care reform ought not be reinforcing the smorgasbord notion of reform.

BILL MOYERS: What do low income women do now if they want an abortion?

TERRY O’NEILL: All right. They have a number of options. They can go to their friends and try to scrape together enough money to have the abortion. This is dangerous for their health, because the longer they wait, the more complicated the abortion might become. That’s number one. Number two, they– some states, in 17 states, there is public assistance for women to have abortions, notwithstanding the ban on Medicaid funding. Some states do provide funding for it.

And number three, there are private funds. There’s a National Network of Abortion Funds that helps women get funding for abortions. And what do other women do? They self-induce. They go to Mexico to find abortion care that’s affordable. Or they continue a pregnancy that is bad for them, that’s bad for their family and that is bad for their economic status.

BILL MOYERS: I hear both of you, but I hear you against the sound of the political world in my ears, as well. And, you know, one long time Washington insider, William Galston of the Brookings Institution, you probably know him, says “The executive order found a sweet spot … Something that didn’t seem to send the base of the party into a tizzy, but seems to have satisfied a very important minority within the party.” Galston says, “It was the model of win-win pragmatism.”

JOHN NICHOLS: Yeah. Win-win pragmatism is the– what we always look for when we say we’re going to do something wrong, right?

And I think the thing to understand here is that, the core of your question’s about politics. How do we do politics in this country. And it’s absolutely true that in the final stages of the House vote on this bill, Nancy Pelosi, who’s proven to be a pretty effective Speaker, had to find about a dozen votes. And she found them in the community of anti-choice, or pro-life, Democrats. Bart Stupak, Marcy Kaptur, and others. And, many of these people who are very liberal. This, you know, it’s an interesting fact. Bart Stupak voted against going to war in Iraq. He’s voted against a lot of these terrible free trade agreements. He’s not the worst guy in the world. He just really opposes abortion.

These compromises are always made. And the most important thing is that we’re here today screaming and yelling about it. And I’ll tell you why. Every bit of social progress in this country has come in what’s best referred to as “reform moment.” A moment when the country is ready to do something on slavery, on child labor, on the horrible construction of our economy during the Great Depression era, on civil rights. There’s always a reform moment.

BILL MOYERS: Social security.

JOHN NICHOLS: Social security.

BILL MOYERS: There was a huge fight. Huge, ugly fight.

JOHN NICHOLS: Absolutely. And so, there’s always going to be a reactionary force that says, “Don’t do anything.” And then there’s going to be a sort of a moderate force that says, “Well, the country’s ready to make some change, let’s do it.” The essential element, I will argue, and I don’t think it’s so self-focused or self-absorbed, is that it’s always the progressives, the people who say, “This is not going far enough,” who ultimately build on the construct and make it into something worthy of the American experiment.

The objections that we raise to this health care bill, the demands that we make that it be improved, that we in fact reform the reform. That’s what’s going to give us a health care system that is humane, that is decent, that is worthy of the United States.

BILL MOYERS: Yeah, but how?

TERRY O’NEILL: Well, one thing that I think that we learned, the women’s movement learned through this process is that compromise in the current political, I guess, environment in Washington looks a lot different from what it might have many years ago. So, for example, when Lois Capps put her amendment into the, I think it was the House Commerce Committee’s version of health care. She put in an amendment that was intended to take abortion off the table. So, she said, “Let’s codify Hyde. We’ll just codify Hyde. Get it off the table.”

BILL MOYERS: Meaning we’ll just–

TERRY O’NEILL: “And move on.”

BILL MOYERS: We’ll just accept it.

TERRY O’NEILL: Yes, yes. Pro-choice. A wonderful pro-choice legislator from California.

JOHN NICHOLS: And she was looking. She was looking for what might classically be described as a compromise.

TERRY O’NEILL: As an actual compromise. And immediately the anti-choice forces on the Republicans party, and Bart Stupak, began saying, so the Hyde Amendment is the pro-choice position. Alright. So, what we’ve learned from that is that in fact we never ever let that happen again. And the certainly my organization is prepared to go to the mat on these issues and not say– look, these are our friends, you know?

BILL MOYERS: You supported the President. You campaigned for the President. He was a friend of the women’s movement. Do you feel betrayed?

JOHN NICHOLS: Women went door to door for him in Maryland, yeah.

TERRY O’NEILL: Prince William County, Virginia. I went to the exurbs where I thought that he might– we didn’t know that he could take Prince William County. I went door to door for him with my “Hillary sent me” button. You know? Absolutely.

BILL MOYERS: Do you feel betrayed?

TERRY O’NEILL: I, you know, of course, the women’s movement has clearly been betrayed by this by this process. The executive order. It was a wrong thing for him to do. I understand the politics of it.

BILL MOYERS: The pro-caucus–

TERRY O’NEILL: The pro-choice caucus–

BILL MOYERS: The pro-choice caucus in the House supported the executive order.

TERRY O’NEILL: I know. I know. And the reason they did was that they compromised. What the alternative at the time, in that weekend, the alternative was going full boor for the Stupak/Pitts language going into the bill. That was the tradeoff. I got a call on Friday evening at 7:30 because what’s happening is Bart Stupak is leading the charge to, at midnight, slip in this extremely, even worse anti-abortion language than what we ended up with. And, so, we worked for the next 48 hours, furiously trying to stop that from happening. And we did. And the pro-choice caucus in Congress said, “Okay, that’s as much as we can do. And now, you know, we’re going to go forward.” That’s their job. You know, you legislators have to make compromises. The National Organization for Women, we’re not elected officials. And we don’t. And we won’t.

JOHN NICHOLS: And, can I just offer, there were a lot of compromises at the end. We’re talking a lot about abortion. And it’s vital to do so. But we should also understand that Congressman Dennis Kucinich, who suggested that he would vote no because this bill was an incredible bailout to insurance companies. And he detailed his criticisms– everything that we’ve said.


JOHN NICHOLS: He detailed before. And at the end of the day, he chose to vote for the bill, and I think in much the same way that the pro-choice caucus did. There were many people who were there in the thick of it over the weekend. And yes, it does become, at least in that moment, a “which side are you on” choice. Are we going to be with the folks who really want to kill this whole thing? Or are we going to fight this fight today? And then turn around and ask, “What are we going to do tomorrow?” And again, that’s what I keep coming back to

BILL MOYERS: What do people want to do, borrowing your term, what do people do who want to reform the reform? Are you going to call the President? Say, “Well, Mr. President I– you let me down this time…” Are you going to say, “You owe me now.” Because we women have mad a sacrifice for your political win”?

TERRY O’NEILL: The President clearly owes the women’s movement. Clearly. I’ve got a whole list of things. I’ve got– I want him to take– what I’m looking for is leadership for women’s rights. I want him to take leadership on finally ratifying the United Nations version of the ERA. The Convention on the Elimination of Discrimination Against Women.

BILL MOYERS: The Equal Rights Amendment, right.

TERRY O’NEILL: The Equal Rights Amendment. I want him to take leadership on that. I want him to take leadership on doubling the funding for the Violence Against Women Act. Because even at double, it’s not going to serve all the needs. But we need to double it now. What my organization is doing immediately is we are seriously ramping up our efforts to repeal the Hyde Amendment. Why? Because Hyde is the basis for this language that actually got into the law that eventually, according to the George Washington University School of Public Health, this law, if it’s not changed, over a period of years, insurance companies, all insurance companies in all plans will eventually conclude that it is too much trouble to offer abortion coverage at all. Eighty-seven percent of private insurance policies today cover abortion care. That goes away if we don’t make changes in this law.

JOHN NICHOLS: And that’s a big fight.

BILL MOYERS: Karl Rove wrote this week that Republicans are going to reform the reform. They’re going to push to repeal it. And they’re going to make it an issue in the November elections. Are you, when you call for reforming the reform, helping the Republicans in their campaign?

JOHN NICHOLS: Not in the least. Look, the fact of the matter is, that’s their job, if you will. And I don’t think this is just Republicans. The fact of the matter is polling shows an awful lot of Republicans think that this, a lot of this reform is very, very good. Already there are divisions within the Republican caucus about whether they’re for full repeal or just changing some of the things. And that’s really whether we’re at.

The fact is, this bill is never going to be repealed. It’s not going to be thrown out. We’ve opened up a great debate in this country. There will be conservatives, even reactionaries who say that the bill must be weakened– must be changed. They will offer their solutions. The only mistake that progressives would make would be to think that it is the job of progressives to defend this bill as is.

If there are pulls from the left and the right, then the compromises, if you will, will be in a good direction. If there are not pulls from the left, if the left simply becomes an ‘Amen corner’ for the bill that was passed, it will get steadily worse, because all the noise will come from the right.

BILL MOYERS: So, what do you want progressives to do tomorrow morning?

JOHN NICHOLS: I’ve seen a rise in energy. I think people do believe that we might actually be in a reform moment.

And it may not be anything we want, but that’s good. If we’re there, then we can start to define things. I’m excited about a lot of stuff that’s happening. I’m in no ways tired. I look at Congressman Alan Grayson from Florida, who has proposed a Buy Into Medicare Act. And he just says, “You know, let’s just say that if instead of forcing people to buy health care from a private insurance company, you can also buy in, at cost, no matter what your age, to Medicare.”

BILL MOYERS: Let’s hear a little of that.

REP. ALAN GRAYSON: This simple bill would allow anybody, any American, any permanent resident, to buy into Medicare at cost. And what it does is it takes this enormously valuable public resource called the Medicare Provider Network and makes it available to all Americans. We’ve spent billions putting together a Medicare Provider Network that stretches from Nome, Alaska, all the way to Key West, Florida. We’ve spent billions doing that, and yet only one-eighth of the population can use it […] I say to those people on the other side of the aisle, if you don’t want to buy into the public option, that’s fine. But don’t prevent me and my family and the ones who I love from doing the same.

BILL MOYERS: Does that proposal have any chance?

JOHN NICHOLS: You know, this is the interesting thing. Alan Grayson proposed it, and it’s four pages long. And I know Congressman Grayson. He put it together pretty quickly.

BILL MOYERS: Democrat from Florida.

JOHN NICHOLS: Democrat from Florida. Real rabble rouser. To his surprise, he’s already got 80 cosponsors. He put a petition up saying, “You know, let’s petition Congress on this.” They were getting people to sign on at a rate of one every six seconds across the country.

The fact of the matter is Barack Obama is a cautious President. It is time to go out and make him do the things that need to be done. And that’s an organizing task.

BILL MOYERS: Understood. But some of those allies of Obama feel very disconsolate now. Because he keeps asking his most devoted constituents, women, gays, unions, African Americans to swallow a few toads, while he battles on behalf of a broader agenda. How long can you wait? How long can you wait?

TERRY O’NEILL: We already waited as long as we can wait. We are, as the grassroots arm of the women’s movement, we are dedicated to going to the grassroots and demanding the change that we really need. Everybody is telling me, “Oh my goodness, Hyde is settled law. You can’t do anything about it.” Fine, that’s what you say inside the beltway. You know, the National– we’re not based inside the beltway. We are based out in the field. We’ve got chapters out all across the country. That’s where we are.

And that’s where people– I can’t tell you how many women I know would like to buy into Medicare today. And I’m one of them. If I could I’d buy Medicare. It’s a great program. My mom was very well-served. So was my dad by that. So, yeah, we’re taking it to the grassroots. And, you know, that’s where President Obama got his great strength. And that is where we are going to get our great strength.

BILL MOYERS: Terry O’Neill and John Nichols, thank you very much for being with me on the Journal.

TERRY O’NEILL: Thank you.

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