I’ve been swayed by the arguments of those who support the Senate bill:
Health care reform does nothing, they cry — except for covering 30 million people, ending overpayment on Medicare advantage, making the first real attempt to use medical evidence to guide health care spending, starting up a wide range of pilot projects on cost control while empowering an expert panel to put the results of those projects into effect, providing financial incentives to limit excess coverage, and so on.
And:
I certainly regard the passage of the health insurance reform bill to be another victory of strategy over tactics. In his first year, Obama will have achieved something that no previous Democrat had managed: universal health insurance. This will be spun away by some. And maybe the infuriated left-liberals and the angry right-oppositionists will get some temporary respite from that. But guess what? He did it. It was as grueling a victory as the one in the primaries, and took even longer. But it was a victory, a substantive, enduring legislative victory the like of which no president has achieved since Reagan.
It will have to be tweaked, as Reagan’s tax cuts were. But like that first year triumph, it will last. For good or ill. And unlike tax cuts announced as pain-free, this was a clearly budgeted, deeply difficult, legislatively complex operation. The only Pyrrhic part of it is the GOP’s celebration of its opposition. Their glee is premature.
Tom Harkin of Iowa had this to say:
One of the public option’s strongest Congressional supporters insisted on Monday that while the Senate is poised to pass health care legislation that does not offer consumers a government-run insurance plan, he will bring the idea up again — most likely after that bill is passed.
Sen. Tom Harkin (D-Iowa) told reporters that the public option is not dead. “It will be revisited,” he said. “I’m just saying, I believe it is so vital and so important that it is going to be revisited. Believe me.” The Iowa Democrat said that “even next year,” senators “may be doing some things to modify, to fix, to compliment what we’ve passed here.”
Harkin also used the metaphor of a starter home:
On Thursday, Iowa Sen. Tom Harkin described the 2009 health care reform bill as buying a “modest home, not a mansion.”
In fact, he actually called it a “starter home.”
“It has a good foundation – it covers 31 million Americans,” he said. “It has a good roof for protection – it cuts down on abuses, and it provides the biggest infusion of money in prevention and wellness that we’ve ever done,” he said during his weekly telephone press conference. “And, we can add additions and extensions to it as we go on in the future. It is not the end of health care, it’s the beginning.”
It’s far from an ideal bill – it will have to be fixed. I’ve described this as the classic reformer’s dilemma – we wanted a lot more but the political realities of America 2009 are stacked against far reaching reform; we have a choice, a tough one, of killing this bill and starting over or of accepting this bill and fighting for future reforms. Part of me wants to kill it and start from scratch but that clearly means months of bruising, bloody political battles with very likely a similar outcome – or very likely a worse outcome.
Some of the changes go into effect pretty quickly, others are delayed. Either way, the debate and the proposals that have been floated have shifted public awareness. The public option polls positively and it’s not going away any time soon. Once the bill takes effect, we’ll start seeing ways to improve it.
Anyway, McJoan at Kos reviews the highlights of the bill – good, bad and ugly.
Social Security and Medicare were both pretty weak programs at the beginning and it took years of work to make them more robust. It’s not ideal, but it was never going to be; the political environment is touch and we have a minority that would rather stop government than go along with making good policy, the economy is staggering and there are two wars on. Just getting something this far is an accomplishment we need to recognize. And we can and will make this better as time goes on.
#1 by Richard Warnick on December 21, 2009 - 4:02 pm
Jane Hamsher:
Go back to the House of Representatives and write a bill that can pass the Senate with 51 votes.
#2 by Glenden Brown on December 21, 2009 - 4:09 pm
Richard – I’m honestly struggling with this one. I get the impulse to kill the bill. There are some unique problems using the reconciliation process – yes, it lowers the bar for votes but may make it harder to get some items through since reconciliation has to be used for budget items only; given the past, we could probably get a better bill, but it means you have severl bills rather than a package deal. Maybe the goal is pass this bill now and get the lame duck Congress a year from now to to pass a public option.
I wonder if the Senate is up to the kind of fight we’d get if we have to start over – I mean that seriously – it’s been brutal and the conserva-dems in the Senate are feeling vulnerable and might very well ditch the whole thing.
#3 by Richard Warnick on December 21, 2009 - 4:46 pm
Glenden–
Our trust has been abused. Key senators are openly threatening the conference committee process, making it unlikely that we’ll see any improvements in the Senate bill.
I’d like to see Senate Majority Leader Reid lose his seat next year– maybe then we’ll be able to start fresh.
If the bill passes in its current form, then the hysterical warnings from the right about a “government takeover of health care” will turn out to be so ironic. We’re witnessing a corporate takeover of the government.
#4 by Ken on December 21, 2009 - 5:24 pm
It’s a starter home that is bound to make the nation house poor.
#5 by Glenden Brown on December 21, 2009 - 6:15 pm
Richard –
There’s some very informed debate taking place across the blogosphere today – Jane Hamscher at FDL has a list of ten specific reasons she would like to see the bill killed. Ezra Klein answers her objections here.
#6 by Richard Warnick on December 21, 2009 - 9:17 pm
Glenden–
I’m happy to enter the talking points war. Jane Hamsher is writing her list in shorthand, but Ezra Klein is too.
(1) Maybe nobody will have to pay more than 8 percent of their income in premiums, but there is no enforcement mechanism for this, and no restrictions on deductibles and co-pays. True, you can’t be rejected for pre-existing conditions but you can be charged triple by the insurance companies.
(2) The penalty for not buying private insurance may be unconstitutional. Keith Olbermann says he will refuse to buy insurance, and urges others to do the same. I don’t know if he will refuse to pay the penalty, and risk jail. It might make an interesting court case. This is a bailout for the insurance industry, plain and simple– instead of a “government takeover of health care,” the insurance companies are taking over the government’s power of coercion.
(3) If you trust the insurance companies and employers to bend the cost curve out of the goodness of their hearts, then there’s nothing to worry about. But there are no cost controls in the legislation. Nothing to stop insurance premiums from continuing to skyrocket. Premiums are expected to double to an average $23,842 per family by 2020. Government subsidies are not available to those of us with employer-based insurance, and what about deductibles and co-pays?
(4) The abortion provisions alone are reason enough to kill the bill. Pro-choice House members tried to make health care “reform” abortion-neutral, but other members of Congress acted irresponsibly and inserted a poison pill into the legislation. If it stays in, progressives cannot vote for this.
(5) Union health insurance plans (now cleverly derided as “Cadillac” insurance) were negotiated in exchange for pay cuts. The Senate bill’s confiscatory 40 percent tax on these middle class benefits is outrageous. The House proposed a tax on millionaires, who can afford to pay.
(6) I found the link Klein was unable to find, however it refers to the delay in implementation of the mandate etc. and not to taxes. Anyway, the point is that there is no reason for urgency in passing a bill that doesn’t take effect for five years anyway.
(7) It’s true that insurance companies can refuse anyone now, but the 300 percent rule is still outrageous. Have you noticed how the insurance company stocks have been doing lately? Up 10-20 percent in the last month.
(8) Here Klein and Hamsher agree that the provision blocking generic drugs ought to be changed.
(9) The issue here is the Obama administration’s secret deal with Big Pharma, which has been widely reported but they still won’t admit it. The proof will be in what President Obama signs into law, won’t it? This is a significant aspect of the total lack of cost controls in the bill.
(10) Five major cost controls? Two of the ones Klein lists (in a separate article) are the individual mandate(!) and the tax on health care plans(!) Both of which take money out of people’s pockets. The other three are “bundled” payments to providers, “prudent purchasing” or exclusion of bad plans from the exchange, and the Medicare Commission. All regulatory powers which might work in favor of consumers, or they might not! These are not cost controls worthy of the name. Why not a public option that pays Medicare rates?
In general, this bill is far too complex (all the better to hide corporate giveaways). The Senate version also features delayed implementation, which had better be changed or the Democrats are handing a perfect disinformation opportunity to the Republicans/tea party crowd.
A reconciliation bill would be simpler, and could include easy-to-understand provisions such as Medicare buy-in at age 55.
#7 by Larry Bergan on December 21, 2009 - 9:26 pm
Glenden:
Ezra Klein offers some pretty convincing rebuttal, but even he agrees with Hamscher on this absolute gift to the {add pejorative here} drug companies which have shown themselves to be bilking us for years, especially seniors.
Jane Hamscher
Ezra Klein
I don’t know. This bill is so complex and sweeping, I’m going to have to know a lot more. The mandatory charges could be the tipping point for some families. The up to 8% charge won’t actually pay for drugs or any other expensive costs that an illness may incur.
Not everything in the bill is bad and that’s hard to even imagine after 8 years of hell, but we’ll see how things shake out.
War isn’t personal except to soldiers these days, but health care is personal to everybody. That could be a good thing it this issue finally gets people off their asses.
#8 by Larry Bergan on December 21, 2009 - 9:42 pm
Whew!
I just read Richard’s assessment of the Hamsher Klein debate.
Great points!
This bill IS too complex and you’re likely right that it’s on purpose. Why would this body do anything different; it worked for the patriot act and HAVA. I am waiting anxiously for Howard Deans stance.
#9 by Richard Warnick on December 22, 2009 - 8:56 am
I just thought of something. Ezra Klein says that the individual mandate only applies to 15 percent of the country. Since it’s such an insignificant feature of the bill, why not eliminate the individual mandate in exchange for losing the public option?
I’d be in favor of that.
#10 by Larry Bergan on December 22, 2009 - 1:35 pm
My biggest concern about the individual mandate is that it will force already struggling families to spend a significant amount of money they don’t have to find out something is wrong with them, but they still won’t have anywhere near the funds to get something done about it with deductibles, drug prices, doctor fees, hospital stays, ect.
This is a bad bill and a gift for the greedy. Why should we leave the decisions needed for controlling costs to the very people who broke the system. It mirrors the banking mess in that regard.
#11 by brewski on December 22, 2009 - 1:46 pm
Larry, where is your concern for struggling familes when it comes to the payroll taxes the left has regressively heaped on them?
#12 by Kevin Owens on December 22, 2009 - 2:39 pm
I would love this bill if I owned a health insurance company. But, sadly, I don’t.
Rather than focus on coverage qua coverage, a better approach would be to focus on making health care less expensive, which would naturally allow more people to obtain it. Not only would this cover the currently uninsured, it would also benefit the rest of us! We could then spend the money we save on education or other worthy pursuits.
Feminist Mormon Housewives posted a couple of very good links about the core problems with our health care system, which I highly recommend. They were very educational for me: More is Less and Someone Else’s Money.
If health care were run more like other industries–that is, if it functioned more like a free market, and less like a perverse monopoly–we’d see higher quality, more affordable care. Right now, health care is bad because patients aren’t the customers–Medicare or insurance companies are. Therefore, the industry makes choices which benefit the insurer rather than the patient, leading to expensive, poor quality care. Any cost-containment approach will have to address this situation.
#13 by Larry Bergan on December 22, 2009 - 5:30 pm
Brewski:
The only progressive tax I remember being “heaped” in the last decade is Obama’s tax break to people making under $250.000. Are those the “struggling” families you’re talking about?
Lower taxes aren’t the answer to everything; snap out of it.
#14 by Dwight Sheldon Adams on December 24, 2009 - 10:13 pm
It occurs to me that one step in “making health care less expensive” is reducing the expectation of enormous pay that exists amongst the life-savers. Whether it be insurance companies, doctors, pharmaceuticals, or medical device manufacturers, everybody has to take their fat profits out. Those profits could use a better diet and a little exercise, if you ask me.
Another step is to determine the most efficient, cost-effective ways to handle health problems. Preliminary diagnoses and referrals might help, using sufficient but not state-of-the-art technology and procedures might as well, and encouraging good patient practices (end-of-life counseling and lifestyle choices, for starters) would also help.
This problem isn’t a politics or industry, industry or individual, individual or politics problem. Every group has to be involved. During WWII and again in the 50s and 60s, government had to become involved in agriculture because the farmers were unable to analyze their presence within the market. Ultimately, though, it was the farmers who produced the crops, not the government, and the consumers who bought them. Like then, we all have a stake in the solution, although some of us might not like what the solution calls on us to do.
Dwight Sheldon Adams
#15 by brewski on December 25, 2009 - 12:03 am
Larry,
Making people poorer isn’t the answer to anything.
#16 by Richard Warnick on December 25, 2009 - 3:51 pm
Dwight–
Back in 1973, I went to hear Ted Kennedy speak at the Georgetown University medical school. At the time, he had a proposal to offer free tuition to med students in exchange for a few years working as primary care physicians on government wages.
Haven’t heard about this idea since then.
#17 by cav on December 26, 2009 - 10:12 am
“As far as I am concerned, any Republican who voted for the Medicare drug benefit has no right to criticize anything the Democrats have done in terms of adding to the national debt,” said Bruce Bartlett, an official in the administrations of Ronald Reagan and George H.W. Bush. He made his comments in a Forbes article titled “Republican Deficit Hypocrisy.”
Bartlett said the 2003 Medicare expansion was “a pure giveaway” that cost more than this year’s Senate or House health bills will cost. More important, he said, “the drug benefit had no dedicated financing, no offsets and no revenue-raisers. One hundred percent of the cost simply added to the federal budget deficit.”
The pending health care bills in Congress, he noted, are projected to add nothing to the deficit over 10 years.
#18 by Cliff Lyon on December 26, 2009 - 4:43 pm
Here, HERE Cav! A devastating blow to say the least.
Have you noticed, the Righties have given up defending the Republican leaders they elected and have instead contented themselves by simply trashing the Senate bill?
Rather disingenuous to say the least.