March 21, 2010

• Final Thoughts on Health Care Reform

  Today the House will vote again on Health Care Reform. If it passes the House, it’s over. We WILL have some kind of Health Care Reform package passed into law. The only question that will remain will be whether it is the Senate version (that already passed both houses) or the Obama version (the adjustments of which would still need to pass the Senate).

  In the end after long periods of contemplation I finally decided that I want the bill to pass.  If the bill doesn’t pass, Democrats and the Obama administration would probably not have the will to re-approach Health Care and pass a more popular bill. If they did, or had they shown any sign of even the slightest willingness to do so, I would say let the current bill die. But they haven’t. And they won’t. They’ve bought into the absurd formulation of the media and the GOP that if this endeavor fails you “Can’t talk about Health Care anymore”. Worse, people really believe it will be the end of the Obama administration. It’s ridiculous. It’s idiotic. But it’s what so many people in Washington and in the media believe.  So if the current Health Reform bill fails, they’ll give up.  That’s the main reason why I want them to pass it.

  On the actual merits of the bill I am much more split. One thing I despise though is the increasing tendency to vilify anyone who votes “no” on Health Reform. It’s one thing to vilify those who are voting no for purely cynical reasons or who are so caught up in their desire to destroy the democrats or Obama that they aren’t really even analyzing the bill on its merits and are making up lies about it. Yeah, THOSE people I can understand vilifying.

  However, there are a LOT of people opposed to this bill legitimately on its merits. The idea that these people, if they choose to vote “no” are somehow being evil and terrible destroyers of history is a sickening characterization. There may be a hundred really good things about the health reform package but there are at least 4 highly controversial components of this bill that are seriously objectionable to a lot of people:

  1.  Significant restrictions on a women’s right to choose
  2. An Excise Tax on high end insurance policies
  3. An Individual Mandate requiring people to buy insurance.
  4. Lack of any form of Public Insurance Program

  These aren’t minor things. They’re pretty BIG things. #1 almost resulted in numerous pro-choice members of congress walking out. #2 almost caused unions to walk out on the process. #3 and #4 both poll horribly with the American people.

  There is no shame, IMO on opposing the bill and voting no on one or all of these grounds.  Especially if you add in all of the little annoyances about the bill like the weird national/state hybrid exchange system, the lack of drug price negotiation and drug re-importation, the lack of a repeal of the insurance industry’s anti-trust exemption, lack of access for illegal immigrants, the restrictions that prevent States from setting up their own single payer systems or other creative health care solutions, etc. I certainly wouldn’t say someone who voted no on the bill for these reasons should be drummed out of the democratic party or should be considered not “progressive” enough.

  However if these are your objections, there are some thoughts that might mollify them a little:

  First the little things. Nobody knows whether the exchange or any exchange will work. That’s the kind of thing I think they can fix in a later bill if it isn’t working and probably nobody will notice. Drug negotiation and drug re-importation are things that can certainly be passed in a separate bill. There is enormous support for it but enormous opposition from the probably all powerful pharmaceutical industry. If Obama fights on this issue later on it could be really good for the country. I wouldn’t bet on it to happen before his second term though. Also though Republicans might well bring up the drug re-importation part if they were to take over Congress and/or the Presidency in order to show their distance from the Democratic party. If they were to do that I think it would be hard for Obama not to sign it into law if he were president. The anti-trust exemption repeal has already passed as a stand alone measure in the House. It could still become law. The illegal immigrant problem is a serious problem so Congress will eventually have to deal with it. Hopefully by creating a path for citizenship for the millions of people in the US illegally. If they do that, then those immigrants will gain access to all the advantages of the new Health Reform system.  States are allowed to innovate but not until something crazy like 2018 or 2019 I think iirc. By that time we’ll definitely no if this reform is a big huge failure or not. If there are restrictions preventing States from innovating they will surely be repealed in that eventuality.

  Now for the major objections.

  #4. There are two paths yet available for the public option. It could be added to the Senate reconciliation bill by a Senator offering it as an amendment. Then it’ll have to go back to the House and this Health Care nonsense will drag on even further. I highly doubt that will happen. The other path is the Medicare Buy In for Everyone bill that currently has over 80 cosponsors in the House proposed by Alan Grayson.  Personally, I think this is a great idea, but I don’t think it will get passed either anytime soon. It IS popular enough that I do think there will be a large and growing movement pushing for this in the immediate future. That’s a good thing that’s come out of the Heatlh Care debate. I hope it keeps us talking about Health Care until we really do make a fundamental change like allowing anyone to buy into medicare. Or better yet, a true Single Payer system. It’s possible the threat of the individual mandate may well encourage more support for this movement. People would much rather pay the government for a service (basically a tax) then be forced by the government to pay insurance industries for that same service.

  #3. If there’s any component of this bill most likely to be stopped it’s this component. Many States, over 30 I think, have already implemented measures to try and make the mandate illegal. This will create numerous legal hassles. The Supreme Court is controlled by very conservative people who I would not bet on keeping this mandate in place. Even if that doesn’t happen, there will be pressure during this upcoming campaign and the next for whoever is in power to repeal the mandate. I would not be surprised at all if a future Congress repeals or adjusts the mandate.

  #2. If the excise tax is as badly designed as many people including me have come to think it is, it probably won’t happen. It’s been pushed back to taking into effect until 2018 too and by then I imagine there will be signfiicant movement to repeal it or change it or push it back further.  If ti does come into effect the hit will be hard and people will immediately cry foul. Hopefully though, the threat of an impending excise tax might encourage the elimination of the gold plated insurance plans that drive up costs.

  #1. There’s really no argument against this. It totally sucks. The only fight seems to be on whether a horrible ridiculous restriction becomes part of the law or a slightly not as bad restrictions becomes part of the law. The worst part about the debate on this issue is that it’s solidified a warped language on the issue of the abortion. The Obama administration and Democrats have legitimized the idea that it’s perfectly reasonable to restrict government funds to pay for abortion. They didn’t even try to fight that notion and it’s unclear that anyone ever will in the near future. This was the last issue that almost derailed HCR at the very last minute and may yet still prevent the bill from passing at the 11th hour. It’s super controversial and really stupid since the HCR debate wasn’t supposed to BE an abortion debate.  One hope that both sides might find soothing is that expanding peoples access to Health Care does statistically significantly reduce the rates of abortions that people actually have. So hopefully the fact that not as many abortions are paid for by insurance won’t be that terrible a thing. Maybe…

  Final opinion. I hope it passes. It probably will pass. But I’m not super enthusiastic about it. You won’t find me cheering in the streets. Nor will I by crying in despair if it fails. I’m just looking for silver linings in a what in every ways seems like a mediocre bill to me. Maybe I’ve just been reading too much about this for far too long and have become too cynical about it all. The big truth about this bill is that it will help many millions of POOR people by expanding access to medicaid, to community health centers, and by giving subsidies for those who can’t afford to buy insurance. Whether or not this solves our long term health care needs, that’s just a really really good thing. We haven’t had any kind of legislation that seriously helps the poor in ages. It just sucks that the way our system is, the only way to get that done seems to be by passing a bill that preserves and entrenches all kinds of corrupt systems. Hopefully though it will shake up the balance of powers in our corporatocracy in some interesting ways. We’ll have to watch and see.

  But my secret little itty bitty hope deep inside is that the bill fails and the utter shock of his biggest endeavor failing causes President Obama to wake up and rise to the occasion. That he could afterward become a true populist leader who works for real systemic change and galvanizes the people onto his side. Then maybe we could get a great health care reform bill passed. And great bills in other areas too. But realistically, that probably just won’t happen. 

  btw my hats off to the Republican party who maneuvered what should have been a totally losing debate for them, masterfully. I despise their tactics, but there’s no doubt they’ve been successful in weakening the bill, dragging out the process, and giving themselves a good position no matter what happens. The can run against the bad components of the bill if it passes, and they can run against Democratic inefficacy if it fails. Don’t know if it will be enough to undue the damage done to the party by Bush but it’s certainly a step in the right direction for them. Provided they don’t ruin it by reacting idiotically to the bill passing.

  Anyway Hooray for HCR?  What are your thoughts?

  • 1:05 pm
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