Democrats should permit current healthcare reform efforts to stop completely. They can’t get anything accomplished if Senate rules require the support of 60 members who have shown no ability to agree upon much of anything except each one believes they should rule the roost. Nancy Pelosi is not above playing hard-ball and the President and Harry Reid should also go for the jugular and full-court press at this late juncture or face the label of “failure” for many years to come.
The current House and Senate healthcare bills must be merged by a Joint Committee before one bill can be voted upon again by both Houses in order to send it to the President. The final version, even if it can make it through such a daunting gauntlet, will also be such a convoluted and complex mess that it will be very difficult to pass. Essentially the legislation has devolved into simply favoring the national subsidizing of large private health insurance companies over any effective systemic cost containment measures. Worst yet, since most provisions would be gradually implemented over an existing dysfunctional system after 2013, the extended fear of the unknown would serve as the basis for the 2010 Midterm elections – a recipe for Republican take-over of Congress.
If certain Senators have killed the public option or Medicaid-buy-in, and other progressive provisions favored by House members, and if any such measures make it in the final bill or are left out of the final bill, either the House or the Senate and their various members, could kill the final merged bill for a variety of reasons. The current healthcare reform is such a staggering complex mess that there is little assurance it will pass in any form resembling the currently-debated bills in Congress. Democrats must act as if there were no tomorrow – or at least there is no political future after 2011.
The process of “Reconciliation” can be used to get federal funding for programs and passing all budgetary measures out of both houses of Congress with mere 51% majority votes and thereby avoiding the 60% Senate supermajority requirement to pass legislation and stop filibusters. This is probably the only way any healthcare reform package is going to be presented to the President for signing. Republicans have been completely worthless, disingenuous, clueless, nihilistic, dilatory, incendiary, and negative throughout this entire process. They should be ignored because bi-partisanship in Washington has been dead for years and Democrats must govern alone when they have the majorities to do so. They face the certain risk of quickly becoming the minority party by doing nothing of clear and significant consequence over the next 12 months.
As a complete alternative to the current healthcare reform bills, Democrats should put together a simple Medicare and Medicaid reauthorization bill extending the programs for an additional period of time in order to make the legislation clearly fall under “Reconciliation.” However they would insert the following language:
Medicaid is hereby terminated in its entirety. Full Medicare coverage is hereby extended to all U.S. Citizens and legal residents as of January 1, 2010. The Secretary of Health & Human Services shall be authorized to fully implement this legislation.”
This short and sweeping legislation would not immediately address any costs considerations but it would solve one-half the problem – the need for universal coverage. The issue of cost containment for the entire U.S. healthcare industry would be greatly simplified. With Medicare-for-All in place, then HHS would only need to concentrate on controlling healthcare expenses from the powerful position of being the single national entity that really has the negotiating power to dictate all healthcare pricing. The President himself said if he were starting over he’d favor the single-payer public option. In a sense, we are starting over because working within the current system is no longer possible.
The actual providers of health services, equipment and medicines would still be in private hands – there would just be one central payer and reimbursement form for all healthcare bills. Private health insurance would still exist to cover many things that Medicare does not cover (certain co-pays, dental, optical and long-term nursing care, and other goods and services limited by Medicare prices). The future marketing and sales of these private supplemental policies to all Americans would be far cheaper since most would not be primary coverage, and they would not be mandatory for anyone to purchase so the competitive free-market would dictate the terms.
If the Democrats cannot get 218 or of their 257 members (85%) in the 435-seat House and 51 Senators out of their 58 Members of the U.S. Senate (88% by disregarding the 2 Independents), then comprehensive healthcare reform should die for a few more years. The vote, regardless of the outcome, would serve as the most straight-forward presentation by Democrats for the 2010 Midterm Elections. At least the electorate would clearly see how many Democrats are willing to side with the best interests of the majority of American people and are willing to stand up to the powerful corporatism and oligarchy that is controlling our government and nation.
Many in the U.S. electorate have no love, trust or respect for any financial institutions, insurance companies, big banks, and other large U.S. corporations. Most people could care less that many individuals who work for private health insurance companies might become unemployed – our country certainly does not exist for their benefit alone.
Private businesses of all sizes would see an immediate financial benefit as they would no longer have to pay to directly provide any healthcare for any of their employees. They could offer supplemental medical plans as incentives to recruit or keep good employees. However all our private enterprises would immediately become far more competitive internationally because a massive hidden expense would be eliminated from their overall operating expenses. They might even be able to hire new workers with these savings.
Most of the 50 states would see an immediate budgetary improvement by the elimination of Medicaid which they partially fund and administer. This immediate change would put them on sounder financial grounds. They would be able to concentrate on creating new jobs in this deep recession and not cutting other state programs to meet a federal Medicaid financial mandate.
If Medicare-for-all passes, it can become effective immediately and we would not have to wait years debating the implementation of various provisions. Every U.S. citizen would be treated equally and could readily understand the same health coverage provisions, both good and bad under the current Medicare system. I would personally favor gradually increasing over a 5 to 7 year period the existing Medicare payroll taxes to cover more of the total costs of the entire system if it were extended to all Americans.
A straight up-or-down decision is possible and needed at this point in time. The entire Democratic Party owes that much to the American electorate so it can decide to continue, expand or terminate the Party’s power in November 2010. The Democratic Party would be better off if the public saw them vote on an easy-to-understand Medicare-for-All proposal rather than the mess of hard-to-understand healthcare reforms currently before the public.
Marc Pascal, ranting all over the place in Phoenix, AZ and wishing everyone a Merry Christmas.