Healthcare Enters Take It Or Leave It Stage

I have never claimed to be the brightest light in the room, which makes me wonder why the major newspaper websites are claiming victory for a healthcare reform bill cobbled together by Senate Democrats. With Sen. Ben Nelson finally aboard, all that does is snuff a Republican filibuster. The floor vote is scheduled Christmas Eve.

A lot can happen between now and Thursday evening. That’s plenty of time for Connecticut Independent yo yo Joe Lieberman to change his mind 144 times which is about every hour on the hour.

To win their support, Majority Leader Harry Reid has promised several hundred millions of dollars to Mary Landrieu for Louisiana and anti-abortion and other special waivers to Nebraska for Nelson. What he give to Lieberman? A CEO job at Aetna? Or any other recalcitrant senator playing King For The Day?

Okay, I get it. If cloture is cut off, the bill will need only 51 votes in the senate to pass on Christmas Eve. That leaves a margin of nine Democratic senators to vote against it. It will provide cover for Democratic moderates that include the likes of Jim Webb of Virginia, Ben Cardin of Maryland, Lincoln and McCaskill of Arkansas, Landrieu, Nelson and … Oops. It’s getting close. What if liberals such as Bernie Sanders of Vermont and Ron Wyden of Oregon join the pack in protest?

Some may call it the art of compromise. I call it prostitution under the guise of principle. While on the subject, the people who the healthcare plan was to help got partially screwed. I say partially because there appears to be some inherent good coming out of this legislation. Stack it up to doing nothing and it looks even better.

The healthcare plan would increase insurance coverage for 31 million more Americans. The Washington Post summarizes the highlights:

Instead of a public option, the final product would allow private firms for the first time to offer national insurance policies to all Americans, outside the jurisdiction of state regulations. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress.

Starting immediately, insurers would be prohibited from denying children coverage for pre-existing conditions. A complete ban on the practice would take effect in 2014, when the legislation seeks to create a network of state-based insurance exchanges, or marketplaces, where people who lack access to affordable coverage through an insurer can purchase policies.

Insurers competing in the exchanges would be required to justify rate increases, and those who jacked up prices unduly could be barred from the exchange. Reid’s package also would give patients the right to appeal to an independent board if an insurer denies a medical claim. And all insurance companies would be required to spend at least 80 cents of every dollary they collect in premiums on delivering care to their customers.

Every American would be required to obtain coverage under the proposal, and employers would be required to pay a fine if they failed to offer affordable coverage and their workers sought federal subsidies to purchase insurance in the exchanges. Reid’s package would offer additional assistance to the smallest businesses, however, increasing tax credits to purchase coverage by $12 billion over previous versions.

The overall cost of the package was not immediately available, but aides said it would be more than covered by cutting future Medicare spending and raising taxes in the health sector, including a 40 percent excise on the most expensive insurance policies. The package would reduce budget deficits by $130 billion by 2019, aides said, and by as much as $650 billion in the decade thereafter.(These projections appear to concur with those compiled by the Congressional Budget Office.)

And, what did Nelson get for playing hardball?

Under the new abortion provisions, states can opt out of allowing plans to cover abortion in insurance exchanges the bill would set up to serve individuals who don’t have employer coverage. Plus, enrollees in plans that do cover abortion procedures would pay for the coverage with separate checks – one for abortion, one for rest of health-care services.

Nelson secured full federal funding for his state to expand Medicaid coverage to all individuals below 133 percent of the federal poverty level. Other states must pay a small portion of the additional cost. He won concessions for qualifying nonprofit insurers and for Medigap providers from a new insurance tax. He also was able to roll back cuts to health savings accounts.

During a news conference this morning, Nelson said: “Change is never easy, but change is what’s necessary in America, and that’s why I intend to vote for health care reform.”

He also vowed to vote against the expected conference reconciliation bill if “anything” in it fails to meet his approval. That’s a hallow pledge unless another nine join him.

Although I would prefer a single payer plan by extending Medicare to all or even by lowering its age limit to 55 or even a robust public option, the Senate bill as I understand it is good enough for starters just like any foreplay.

I do not subscribe to the doomsday vision that the bill should be defeated as championed by Howard Dean and Moveon.org. It’s gone too far and torn the country apart simply through the debate process. What glitches crop up can be fixed or killed by future congresses.

I expect hundreds of tiny details to expose themselves as time goes by and the bill is honestly vetted. One horror story repeated on MSNBC is that some insurers will comply by offering coverage to patients with pre-existing conditions but at premiums up to five times higher than those without.

One thing we can all agree upon. The healthcare and insurance reform bill was the focus of a national debate. That’s a far cry from the Bush administration which said “trust me” as it bullied us into the invasion of Iraq.

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Author: JERRY K. REMMERS, TMV Columnist

Jerry Remmers worked 26 years in the newspaper business. His last 23 years was with the Evening Tribune in San Diego where assignments included reporter, assistant city editor, county and politics editor.

  • elrod

    Very well said. This is – WAS – a very difficult and exhausting process. But I'd much rather be here talking about how to tweak it going forward than wondering how to start over again in 12 years.

  • Leonidas

    Not convinced yet that Bart Stupak is sold. Have to wait and see he might join a filibuster. He has a whole lot of leverage right now.

  • D. E.Rodriguez

    Better get used to it. Despite all the filibustering, all the obstructionism, all the nay-saying, all the scaremongering, all the lies, health reform will pass by Chrstmas.

    Twenty years from now, Americans will look back on this legislation—albeit finetuned, improved, etc—with as much acceptance as they now regard Social Security and Medicare.

    Merry Christmas!

  • dduck12

    The healthcare plan would increase insurance coverage for 31 million more Americans. The Washington Post summarizes the highlights:
    The healthcare plan would increase insurance coverage for 31 million more Americans. The Washington Post summarizes the highlights:”

    Beating my head against the wall Department: Please explain why many of the healthier people not buying insurance now, will miraculously sign up? They don't have to if the fine is lower than the premium.
    And, also explain why a healthy person shroud not drop his insurance, pay a small fine, and only take out insurance for himself and his family after he perceives a health threat?

  • jkremmers

    Stupak is in the House and can't filibuster. — Jer

  • jkremmers

    Those are individual decisions. He pays total hospital bill if he gets seriously ill. It's a risk taxpayers should not pay. As we all know, youth is indestructible. — Jer

  • dduck12

    Not really, there will be millions not signing up and many millions jumping off. Result a sicker pool. Insurance 101.

  • Silhouette

    Meanwhile people are dying like flies and/or going bankrupt under the whip of MedMob and the world's supposed “first nation” has the health standards of third world countries.

    The stark facts in the world of reality are that people are, and still will have to choose between having a roof over their heads or curing their normal set of human ailments. High premiums and high deductables are hamstringing the middle class and shoving its members into the classes poor. Our GNP will decline as our debt soars. This healthcare thing is more of the same, sacraficing the solvencey of the USA on the altar of keeping a few dozen fat rich men nice and fat in the interim. They are cutting their own throats in this way…but then again they always have the new bulging middle class in China to market to. Ironic….and we just sit by and watch this crap happen.

    This is utterly shameful in a supernation filled with companies declaring world-record profits. This is the polar opposite of patriotism. Just disgusting. May each and every person responsible in the smallest way for this abortion of human justice fry in a lake of fire for eternity. All the blood shed to preserve the fiscal integrity of this nation and this is the thanks we get?

  • ProfElwood

    Probably true, but Social Security, Medicare and Medicaid aren't going to be looking so great in a few years.

  • Leonidas

    Stupak is in the House and can't filibuster. — Jer

    Doh, you are correct, he can raise a rukus but not filibuster. What I get for posting with a fever.

  • Leonidas

    Better get used to it. Despite all the filibustering, all the obstructionism, all the nay-saying, all the scaremongering, all the lies, health reform will pass by Chrstmas.

    Twenty years from now, Americans will look back on this legislation—albeit finetuned, improved, etc—with as much acceptance as they now regard Social Security and Medicare.

    Merry Christmas!

    Well I guess they found out how many millions it would take to buy Nelson.

    Another indicator that Jefferson had it right

    A democracy is nothing more than mob rule, where fifty-one percent of the people may take away the rights of the other forty-nine.
    –Thomas Jefferson

  • Leonidas

    If this does get through, I'll be waiting for the Supreme Court ruling on the Constitutionality of making people required to carry healthcare or face fines and/or jail time. I could see this part of it being stricken down.

  • D. E.Rodriguez

    Probably true, but Social Security, Medicare and Medicaid aren't going to be looking so great in a few years

    Actually, Social Security and Medicare have not been “looking good” for several years already. Nothing good comes free or cheap. On the other hand, I wonder how many of the millions and millions of SS and Medicare beneficiaries would like to go back to the good old days of everyone one for himself—the days when certain folks called SS and Medicare “un-American, radical, Socialist programs…” Deja vu? (Sorry don't have my special characters codes available)

  • JeffersonDavis

    “Twenty years from now, Americans will look back on this legislation—albeit finetuned, improved, etc—with as much acceptance as they now regard Social Security and Medicare.”

    Hey Dorian…. Merry Christmas, brother!!!!!

    Saying that about healthcare being regarded like Social Security and Medicare isn't really a point for the positive column. Every time I see my paycheck stub and see what they take out for Social Security and Medicare, I really don't regard it well. That, coupled with Congress's abuse of the funding of both, doesn't give me a squishy feeling about Healthcare.

  • D. E.Rodriguez

    MerryChristmas to you, too, JD.

    “Every time I see my paycheck stub and see what they take out for Social Security and Medicare, I really don't regard it well.”

    Actually, I have “seen what they take out for Social Security and Medicare” for several decades and, surprise, I feel good about it. I feel good that whatever was taken out of my paychecks for all those years has helped so many who have gone before me into their golden years, is helping many others right now (including, I am sure, several of your senior relatives, JD) and will help you and yours in your golden years. You're welcome. (Yes, I know, you'll have TRICARE for Life–as I do—but why shouldn't other Americans enjoy such security and benefits in our great country?)

    Just a Christmas thought

    Dorian

  • DaGoat

    f this does get through, I'll be waiting for the Supreme Court ruling on the Constitutionality of making people required to carry healthcare or face fines and/or jail time. I could see this part of it being stricken down.

    It'll be interesting to see how that turns out. Requiring people to purchase a commercial product seems constitutionally questionable, tossing them in jail if they don't even more so.

  • dduck12

    It's ironic, like all of this Tower of Babel HCR, that from a sound insurance standpoint, everyone must be in the insurance pool. So, what now? Ruin the concept and declare a mandate unconstitutional, or somehow accept the “mandate', legally.
    Best option, change this Frankenstein HCR effort into a Health Care Improvement (HCI) effort. The incremental approach, mentioned by some of us (I hope we are the, so called, “moderates”; who knows, labels are fungible).

  • Leonidas

    http://www.washingtonpost.com/wp-dyn/content/ar

    Nelson also secured full and permanent federal funding for his state to extend Medicaid eligibility to everyone below 133 percent of the federal poverty level. The bill would require all states to do so, but Nebraska alone would not be required to pay a portion of the additional cost after 2016.

    This is the level democrats have sunk to to pass their bill.

  • JSpencer

    I call it prostitution under the guise of principle. ~ JR

    Well said, and that would extend to much of what goes on in Washington anymore…. unfortunately.

    the Senate bill as I understand it is good enough for starters just like any foreplay ~ JR

    Yup, and that's the way to look at it, as a beginning. I hope it is a beginning that will eventually evolve into a single payer system one day.

    As for SS and medicare deductions, I have no problem with these, and have been paying the rather meager deductions for forty years. Neither do I have a problem with most of my property taxes going to education twice a year – even though I don't have any kids in school. Education, healthcare, and a safety net for poor seniors are good and worthwhile things that we can feel proud about pitching into as a team, especially when compared to other things that money is wasted on, including corporate welfare and give aways, and a military industrial complex that has grown out of control, etc.

    Perspective and priorities folks, that's what it all comes down to.

  • JeffersonDavis

    Dorian,
    I feel the same way about helping those who can't help themselves in their golden years. I really do. But I was talking about the mismanagement of the funding by Congress. They've raided it from both sides of the aisle and it sucks.

  • D. E.Rodriguez

    I appreciate your thoughts, JD.

    Fiscal mismanagement, as harmful and wrong as it is, is sometimes the price we have to pay. However, I would rather “fiscally mismanage” the cost of providing millions of Americans affordable health care than fiscally mismanage the cost of an-almost-nine-year unnecessary war (And I don't mean Afghanistan…)

  • DLS

    The trend is unmistakeable, and the Dems have wrecked their own effort and can blame nobody but themselves. But it's not final yet and not yet at “take it or leave it,” [Mr. President] stage.

    More concessions to some holdout Dems are conceivable (at what cost, with what “sweeteners,” who knows). The trend goes against too much last-minute lib-Dem overreach again by the House people in conference, but they still can try to get more lefty and left-shifted stuff in the legislation. What may now complicate things is if some House Dems may have learned from Senate follies how to hold out and get goodies for yourself or your state, or House district. We haven't gotten past that potentiality yet.

    Also still open to question is if others will face reality and accept what they can get now (which is the best they can get for a while, obviously) rather than whine like the far lefties on radio about all the grand unrealistic stuff they never stood much of a chance really to get, and which shouldn't be mourned now, but which they still are angry they didn't get and which they actually thought they should have gotten.

  • DLS

    “Best option, change this Frankenstein HCR effort into a Health Care Improvement (HCI) effort. “

    Some of us stated from the beginning that they should have sought true reform and concentrated on and kept only to that, rather than extend themselves into all kinds of other things. I'm unsure many on whom the advice (and numerous lists of concrete, tangible reform element examples) was wasted will ever learn.

  • DLS

    “This is the level democrats have sunk to to pass their bill.” [big Nebraska vote "sweetener"]

    This is a likely model (above which to bid or demand more, of course) for House Dems to follow now.

  • DLS

    “Saying that about healthcare being regarded like Social Security and Medicare isn't really a point for the positive column.”

    The programs are failing and balancing the problems of salvaging most of these with causing pain for the taxpayers of the future is not going to look or sound nice. (This is the “equilibrium” I've long predicted, that the federal legislators will be struggling to achieve — spreading the pain to both major groups while attuning themselves to limiting how loudly either group will howl, relatively.)

    The failures and related problems are inevitable, no matter how bad things get in the future for Boomers and others who might actually be led to believe and to expect a greater fraction of their retirement income and other benefits from the federal government, rather than the significantly less that logic has long demanded. (Don't be surprised if many actually believe Social Security benefits later are seen as inadequate and a viewpoint not seen since the 1960s happens again, redefining “dignity” upward in addition to facing many people retiring with next to nothing — relying on Social Security for more than the small fraction of retirement income that we have long been led intelligently to anticipate.)