Olympia Snowe, put up or shut up on healthcare reform's flaws

In George Packer's long dossier of Senate dysfunction, Olympia Snowe repeats for the umpteenth time that she voted against the healthcare reform bill because she was shut out of merging the Finance Committee bill, which she help forged and voted for, with the HELP Committee bill:

Snowe also voted for the Finance Committee’s health-care-reform bill last October, the only Republican to do so. But in December, at the pivotal moment, she voted against the version that went before the full Senate. “I wasn’t interested in expanding this program beyond the Finance Committee version—it grew by a thousand pages,” Snowe said. She wasn’t included in the negotiations with White House officials that took place in an elegant conference room across from Reid’s suite of offices, and said that the Democrats “did not accept any of my proposals. As I said to the President, it was all windup and no pitch.” 

Snowe here resorts to the Republican fallback position of ridiculing numbers of pages rather than specifying what she didn't like in substance.  The enacted health care reform law is similar in its essentials to the Finance Committee bill -- about which Snowe had this to say to Ezra Klein on October 16, 2009:

You mentioned the Gang of Six. Looking back, would you consider that process a success or a failure?

It was an outstanding process. I think that if the American people had had a window into those deliberations people would have felt very encouraged. It’s a rarity today in many ways to have that opportunity to sit down with your colleagues, face to face, several days a week for multiple hours, just working through issues. It didn’t culminate in agreement, but it did establish the foundation and essence for the legislation that was ultimately reported to the Senate Finance Committee.

The final bill, moreover, meaningfully addressed Snowe's core concerns as she framed in the immediate wake of the Finance Bill's passage.  On October 13, 2009, she told a "scrum" of reporters, according to Suzy Khimm, that she wanted to 1) improve affordability for those Americans eligible for subsidies; 2) open up the health care exchanges, making more Americans eligible to buy insurance in them; and 3) reject the public option but enact a "trigger" that would create a public option at a later date if insurers failed to keep prices below a target.

Well, the final Senate bill provided more generous subsidies than the Finance Committee bill, and the reconciliation bill that addressed House concerns made them more generous still. The ratio by which insurers could charge older policyholders more than younger ones was reduced, a particular Snowe concern. It's true that Snowe was more interested in increasing "affordability" by lowering the value of insurance offered than by subsidizing it more heavily -- but the increased subsidies were financed, keeping the bill better than deficit neutral, an alternative that Snowe told Klein in the Oct. 16 interview that she could accept. As for widening access to the exchanges: the Finance Committee rejected the Wyden Amendment, which would have opened the exchanges to all employees -- but the final bill included a much scaled-down version, opening the exchanges to those for whom buying the insurance provided by their employers exceeded a certain percentage of income. As for the public option, it is, of course, history -- and Snowe was more concerned about keeping it out of the bill than about making sure that her trigger got in.

On a more philosophical level, Snowe's response to what Klein flagged in a subsequent post as a "throwaway question" was in a sense the most thoroughgoing endorsement on record of the bill we actually got:

What’s the single idea you’d most like to see in the bill but that you don’t think is politically feasible?

That’s a good question. You mean politically feasible?

Yeah. Like single-payer, for some people, or Wyden-Bennett for others. A big idea you’d like to see included but is currently outside the range of discussion.

I don’t know that I have anything in that category. I believe we should build upon the current system. We don’t want to disrupt that. I’m traditional in my approach towards reforming health care. Given the size and the amount of money we spend on it, I think it would be far too disruptive to upend the system. I think it’s preferable to build on what has worked well in our system and change the egregious practices in the insurance industry.

What Snowe wanted is what we got: a bill that gives the health insurers 30 million new customers in exchange for some new taxes and tighter coverage rules. Can't get more conservative than that in an attempt at systemic reform.  Olympia Snowe's objections to the final product have always been unspecific and incoherent.

The second half of the Packer paragraph cited above seems to capture the real reason for her rejection of the final Senate bill and the final Senate bill + reconciliation bill package:

McConnell was able to exploit her alienation. A friend of Snowe cited another reason for her reversal: “She actually said to me once that she had never felt the pressure that she felt on health care, never before had that pressure been quite as evident to her or quite as real or troubling. Kyl and McConnell were saying things like ‘You just can’t let us down, we’re all in this together. You’re a senior Republican member of this caucus, and you just have to hang tough with us. We expect it and you’re going to do it.’ ”

It's time for Olympia Snowe to put up or shut up. What in those alleged thousand new pages was the dealbreaker for her? (The plain-English version of the final bill was about 300 pages; technical legislative language inflates the word count of all bills.)  In what way is the enacted Patient Protection and Affordable Care Act fatally flawed?