Health care debate exposes regional rift for Democrats

McClatchey News: Congress' efforts to overhaul the nation's health care system are plagued by an age-old urban-rural, east and west coast vs. the heartland schism in the Democratic Party.

The divide is constantly evident. Last week, for instance, Rep. Pete Stark, D-Calif., chairman of the House Ways and Means Health Subcommittee, offered a glimpse of the tension when asked about health care co-ops.

"Well, the only co-op I know about is when I used to milk cows and we sold the milk to Golden Guernsey. And I think there's only one co-op left," said Stark, who considers the co-op idea a non-starter. "There aren't many of you listening who remember the co-ops of the '30s, which was a — just kind of a Roosevelt outgrowth of rural electric co-ops, phone co-ops."
The same day, Rep. Charlie Melancon, D-La., a leader of the conservative House of Representatives Democratic Blue Dog Coalition, announced he was running for the U.S. Senate.


He promised a "more bipartisan, more disciplined" approach, and touted himself as a "pro-life, pro-gun Southern Democrat."

Stark and Melancon are typical of the party's division. "The two sides don't understand each other. They're reading from different scripts," said Steven Schier, professor of political science at Carleton College in Northfield, Minn.

The divisions, however, already have affected the issue that appears likely to make or break the progress of health care changes — whether to adopt a "public option" insurance choice or endorse creation of co-ops to help make the health care system more efficient.

The co-ops would be non-profit organizations that would run themselves. Members and an elected board would make decisions about premiums, benefits, deductibles and co-pays.
The co-op idea is getting serious consideration from negotiators at the Senate Finance Committee, all of whom come from smaller, less urban states. The chief backer is Sen. Kent Conrad, D-N.D.


"It has appeal on both sides," he said. "It's the only proposal that has bipartisan support."
The idea of co-ops has been met by derision and outright hostility in Congress, however.


"It's a way to avoid and a way to silence what I consider to be a pretty strong drumbeat for a public option in the country," said Rep. Raul Grijalva, D-Ariz.

The small-town Democrats, however, worry about the cost and the government's reach. The 52 members of the House's conservative Blue Dog Coalition have threatened to derail any plan with a public option unless costs are reined in.

Last month, five Democrats on the House Energy and Commerce Committee, including Melancon, opposed the leadership's overhaul bill, saying he feared it would wound the private sector and help encourage publicly funded abortions.

Waxman insisted the 31 Democrats voting for the bill represented a broad coalition of "conservative, moderate and progressive Democrats." Passage came only after four conservative Democrats won changes in the bill they considered more fiscally responsible.

"We came to the table wanting to squeeze out costs," said Rep. Mike Ross, D-Ark.

Conrad's plan would have Washington "guide the creation of co-ops by setting standards and providing the seed money," though just how much is unclear.

To a lot of urban lawmakers and their constituents, the co-op concept is foreign.

"I don't think cities understand co-ops as well as rural areas and the South where cooperatives are prevalent," said Donna Christensen, a Democratic delegate from the U.S. Virgin Islands and a physician.

"There are three political parties in this country — Republicans, Southern Democrats and the rest of the Democrats," said Thomas Whelan, associate professor of social science at Boston University. "And the Southern Democrats are always in play. They have enough people that they have leverage."