Tuesday, December 15, 2009

Notes on the current stage of the Health Care Reform bill.

The political effort towards passing health care reform is approaching the climax. This is going to be a time we all look back at and ask "What happened?" Well, here are a few notes to try to catch a bit of the zeitgeist. A lot of stuff has actually been settled and everyone agrees on it. The questions remain about only a rather small number of things that are not settled. For several weeks the largest of those things was the fate of the public option, but it appears that Joe Lieberman's ego (and maybe his retirement plan) have settled that one for us.

From TPM Reader JM It looks like killing the public option in any form is more important to Joe Lieberman than is getting the HCR bill at all.

My question: Does the U.S. Senate create narcissists or just attract, hold and maintain them?

Why is it that the Republicans under Bush could pass what the wanted through Congress and the Democrats can't? TPM Reader JM also suggests a reason for this. The Republicans wanted only one thing - tax cuts and more tax cuts. As long as they all agreed on what they wanted, they could ram it through Congress. It's quite clear that the Democrats do not suffer from such a lack of thought and imagination.

Evan McMorris-Santoro reports that House Majority Leader Steny Hoyer says the House will accept a health care reform bill without the government-run insurance. I guess the House Democrats agree with me that what is left if the HCR bill is worth saving. What's left includes ending screening for preexisting conditions and subsidies to allow more Americans to buy coverage.

Brian Beutler reports that Obama is encouraging Senate Democrats to "get this done." Obama was speaking to a gathering of roughly 12 Democratic Senators and, according to Sen. Bob Casey (D-PA) was giving them the big picture as well as motivational advice. This was rather obviously intended to counter the tendency of individuals in the thick of the battle inside the Senate to fixate on one or two aspects of the bill, like the public option, and forget what the overall goal is.

Josh Marshall writes that the chorus of frustrated Democrats who complain that the Senate HCR bill has been so watered down as to be worse than useless is not matched by the attitudes of the hard core policy wonks who understand and closely follow health care reform. The hard core wonks are disappointed, but they still generally want to keep what is left rather than just throw the whole thing out and start over. Personally I agree that there remains a lot of improvement in the system that should not be abandoned in a fit of pique just because so many very important things (like effective cost containment) have been blocked. I think that if the "It's not enough! Throw everything out and start over!" crowd get their way, the will to get even this far will not be there for a decade or more and that cost is way to high. Throwing out what is left would also be politically disastrous for the Democratic Party, and the Republicans who would replace Democrats are NOT going to even address this set of problems in any realistic manner. Nor would they do anything else except steal from the government and cut taxes on the rich. No. I don't think much of the incompetents, hacks, thieves and religious bigots who make up the current Republican Party.

Steve Benen addresses the question - How is it that the Republicans under Bush could get legislation through Congress without a 60 vote minimum and for some reason the wimp Democrats can't?

AARP has announced that it supports the health care reform bill. They point out that it will
  • Give the uninsured and small businesses access to quality affordable plans
  • Close the Medicare Part D coverage gap or “doughnut hole” by 2019
  • Eliminate cost barriers to preventive care
  • Reform Medicare's payment and delivery system to promote care coordination
  • Reduce hospital infections and preventable readmissions
  • Strengthen home and community-based care and assist individuals in saving to meet future long-term care needs
It is my opinion that scrapping the current piece of crap coming out of the Senate in a fit of angry pique and anti-Lieberman emotion will prevent these things from happening for at least a decade. The last time (1993) it was 16 years before the issue could even be brought up.

Kevin Drum thinks that what's left of the Senate Healthcare Bill is worth saving. He points out among other things that we still get community rating You have to be an in-depth insurance policy wonk to realize it, but that is really big and in my opinion is worth passing all by itself! But right now we can get it along with laws preventing insurance companies from refusing to provide insurance because of preexisting conditions and also ending the insurance company practice of cancelling the policies of those who get sick (Recissions.)

Here's the final paragraph of Kevin's article:
"Ten years ago this bill would have seemed a godsend. The fact that it doesn't now is a reflection of higher aspirations from the left, and that's great. It demonstrates a resurgence of liberalism that's long overdue. But this is still a huge achievement that will benefits tens of millions of people in very concrete ways and will do it without expanding our long-term deficit. Either with or without a public option, this is more than Bill Clinton ever did, more than Teddy Kennedy did, more than LBJ did, more than Truman did, and more than FDR did. There won't be many other times in our lives any of us will be able to say that. So pass the bill. The longer we wait, the worse it will get. Pass it now."
I'm sure it comes as no surprise that I very much agree with Kevin on this.

Addendum 11:35 pm
Well, well. Apparently there is a reason for Joe Lieberman to pull the plug on the Medicare buy-in even though he supported it himself three months ago. The Washington Post reports that before the Medicare buy-in was killed the influential hospital and physician lobbyists were furiously contacting Democratic Senators to get the plan killed. The details of the lobbying effort provided in the story are quite interesting and tell us why we are getting the Rube Goldberg legislation that is currently being discussed.

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