Jay Rockefeller has waited a long time for this moment. Since 1964, to be exact. So he was unabashedly emotional as the Senate Finance Committee neared completion of its work on health reform. "I feel the way I feel and I am who I am," the West Virginia Democrat said at the end of a teary, post-midnight monologue about his work as a VISTA volunteer 45 years ago.
Who is he and how does he feel? The great-grandson and namesake of America's first billionaire, John D. Rockefeller IV is a 6-foot-6, 72-year-old Harvard graduate who studied Japanese in Tokyo and Chinese at Yale. He's also a longtime advocate of health care for children and the poor – and, as Congress moves toward its moment of truth on health care, perhaps the most earnest, dogged Senate champion of a nationwide public health insurance plan to compete with private insurance companies.
"I will not relent on that. That's the only way to go," Rockefeller told me in an interview. "There's got to be a safe harbor."
President Obama often says a public option is needed to drive down costs and keep insurance companies honest. To Rockefeller, it's both more basic and more vital: The federal government is the only institution people can count on in times of need. To conservatives, that same government is inefficient, intrusive and, in Iowa Sen. Charles Grassley's words, "a predator" in the market. The coming clash promises to be a defining moment, for Rockefeller, Obama and both political parties.
The Senate Finance Committee is expected to approve its bill this week, and it will not have a public option. Rockefeller's version lost 15-8, and a variation from New York Sen. Charles Schumer lost 13-10. The heated committee debate previewed what will be a similar but higher-profile debate on the floor.
Will the end result be the same? Rockefeller sees these reasons for hope:
- Four other House and Senate committees produced health bills that have a public option.
- A Finance Committee member came up to him after the public option vote, "somebody who had not necessarily voted for it," and told him to stick with it because "it could work out well in the end."
-The Senate is fluid. Tweaks may draw new support for a public option. Some people may agree to vote to shut off a filibuster, which takes 60 votes, even if they oppose a public option or a bill that includes it. "People make speeches in July or August, 'this is my line in the sand,' and then life gets to be a little bit more realistic. People can change. Pressure is brought to bear. The president enters the situation."
-"The president wants it, he told me personally. I think he will work very hard for it." When the House and Senate are ready to reconcile differences in their bills, "you may have that conference in the Cabinet Room at the White House. The White -House is going to be very, very much involved in that."
- Other alternatives are weak, and the Senate floor is a good place to expose their weaknesses.
Rockefeller is dismissive of consumer-owned co-ops, such as Democrat Kent Conrad of North Dakota has proposed, as an alternative to the public option. They are mostly associated with farmers and utilities and "they generally went out with World War II," Rockefeller told me. Of the few health care co-ops, the best is in Washington and yet, Rockefeller points out, both senators from that state voted for a public option. "That should tell you something," he said. (So should the Congressional Budget Office conclusion that co-ops wouldn't have much impact in most markets).
He is equally critical of proposals that would allow states to create public plans or open their state employee health systems to state residents, either immediately or if insurance companies don't meet certain standards of coverage, affordability or competition. "Triggers don't work," he said, and state options would leave uninsured people subject to the whim of a governor or the fiscal condition of a state.
Furthermore, if you bought a state policy, what if you moved? Say, from West Virginia to Oklahoma? "Who's going to regulate? Who's going to watch? I don't want it to be the folks from Oklahoma. Because I have a feeling they don't pay a lot of attention to those things," Rockefeller said. Bottom line: "There are some things that require broader authority."
In the end, Rockefeller's own line in the sand might have to change. I asked if he could ever accept any kind of trigger. "Generally you don't say never," he said.
Rockefeller's distrust of the insurance industry is profound and not surprising. I met him when he first became governor of West Virginia in 1977. His populist crusades back then included trying to buy, and then condemn, flat land owned by a big development company so flood victims could move to houses off the flood plain.
Now he says he expects insurance companies to evade whatever new rules are adopted under health reform, and some experts agree with him. Rockefeller successfully fought last week to preserve the Children's Health Insurance Program rather than move low-income children onto a new exchange, or marketplace. CHIP provides benefits tailored to children, he said; on the exchange, they'd be "at the mercy of private insurance companies."
Rockefeller also plans to push his proposal to prevent misuse of new federal subsidies meant to help low- and middle-income people buy insurance. Under his proposal, he says, insurance companies would have to use at least 85% of the subsidy money for medical care -- instead of profits, salaries, trips and "mausoleums of buildings."
In his negative view of the insurance industry, Rockefeller is well within mainstream public opinion. He's out of fashion, though, when it comes to his faith in the federal government, a faith that dates from seeing poverty up close and personal in the coal mining town of Emmons, W.Va. He arrived the same year President Lyndon Johnson declared a "war on poverty," a year before the Medicaid and Medicare programs were signed into law.
The impact of those days on Rockefeller – he became a West Virginian and a politician – was clear to members of the Finance Committee and whoever was watching its deliberations on C-SPAN Friday at 12:17 a.m. He haltingly told the story of the job interview he got for Eddie, 18, at Union Carbide in Charleston. Eddie had never been to Charleston, 45 minutes away. He had never seen a traffic light or an elevator or a Venetian blind. When the interviewer suggested that Eddie let the blinds down to keep the sun out of his eyes, the teen-ager fiddled with the ropes, became humiliated and finally "hung his full weight" from the bottom seven or eight slats. Nothing moved.
At this point, Rockefeller apologized for choking up. He said Eddie sat down and the interview proceeded – "but he couldn't give his name. He'd been stripped of all self-worth. What I'd done to him was substantially damaging to him ... He had me by his side and it didn't work. He had Medicaid by his side and it did work. So I like to keep poor people where they have health care benefits." He said he can't bring himself to look at his typewritten diary from his Emmons days, and teared up again.
You don't get crisp sound bites from Rockefeller, or the charisma of a Kennedy. He's not a fixture on Sunday talk shows and he's never run for president. In fact, in 1991, Rockefeller toyed publicly with the idea and refused for some time to rule it out. He told me back then that he didn't want to end the White House speculation because it kept people interested in what he had to say about health care.
That's hardly the problem now. "There is no air in Washington, there is no oxygen, that is not sitting on a table called health care. It's very, very intense," Rockefeller said. After the committee vote this week, there will be work to merge its bill with another Senate health bill. Then there will be the floor fight, and then the House-Senate conference committee.
"All that time I'm going to be battling to keep what we've won and get what we haven't won," Rockefeller told me. An opportunity like this comes once in a lifetime, he said, and can't be ignored.
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