Take Time to Celebrate the Health Care Bill… Sort of
As the Senate prepares for yet another post-midnight vote under cover of darkness to pass a bill which underwent a massive revision only hours ago, observers on both sides of the aisle should take a moment to count their blessings on this score, limited though they may be. Back during the summer I took part in a panel discussion with a few people, including Rick Moran and Ed Morrissey, where I predicted that Congress would eventually pass something with the words “health care” stamped on it, but it would probably be a mostly empty, expensive shell that made virtually nobody happy. (I’m putting my crystal ball up on E-bay later today for those who would like to improve their prognostic skills.)
But before you put in your bids, remember that this isn’t a done deal yet. Getting the House and Senate versions hammered together into one bill that will pass muster still remains as a trick worthy of Houdini. But for the moment, let us assume that it’s going to happen and see what we’ve gotten and what bullets we’ve dodged.
First of all, though it may surprise some readers to hear me say it, there actually are a few good things in the bill. (At least what we’ve been allowed to see of it.) Some low income people will actually wind up with a chance at affordable insurance, though not all and not in the more direct, cost-effective method many of us had hoped. There will be some reforms in provider practices, such as the odious pre-existing condition clauses and improvements in portability for those changing jobs. And, if nothing else, we should see less of those annoying Jersey Shore type people wandering around after that 10% tax on tanning beds kicks in.
For those inclined to side with the GOP, this may also be a time to remember some of the things that didn’t get shoved down our throats with this bill. The disastrous, European style single payer scheme never really got off the ground. The so called “public option” which would have crushed a significant segment of the nation’s private industry has faded into the sunset. And the proposals to suddenly shove a huge glut of new people into a Medicare system which is already heading for a cliff did not really come to pass. (We’ll have to wrestle with the Medicaid question later.)
Of course, I don’t expect my doctrinaire conservative friends to be doing back-flips over this “good news.” I freely admit that the high points I listed come with a distinct flavor of, “So, other than that how did you enjoy the play, Mrs. Lincoln?” But in the spirit of the holiday season it is worth remembering that it could have been much, much worse.
So what is lacking in the bill which we would have really liked to see? Let’s count the missing in action items:
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Robust interstate competition between insurance companies to reduce costs? Didn’t make the cut.
Tort reform? Never even stepped out of the locker room.
Meaningful Medicare reform to improve its long term viability? Covered in a smoke screen and effectively gutted.
What’s the biggest and latest in the list of atrocities which should seriously put a bee in your bonnet? That would be the pieces of silver (both figuratively and literally) paid to Ben Nelson for his last minute support. The proposed changes will be dumping increased Medicaid costs onto the states… unless you live in Nebraska. 49 states and the District of Columbia will be shouldering those costs. But if you happen to live in Nebraska, you’re in luck! The rest of us will be paying that tab for you. Originally it looked like this situation would only last for three years, but as of this morning it appears that Nelson has secured a deal to keep that bonus in effect in perpetuity. Congratulations, Corn Huskers!
The fact that such a deal could even be considered, to say nothing of enshrined in Federal law, is an abomination. But I suppose nothing should shock us too much any more.
But still, as I said in the beginning, we should all put on our rose colored glasses if need be and realize that maybe… just maybe… some good will come from all of this in the end. And the system can always be modified in years to come if and when any really serious problems emerge.
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9 Responses to “Take Time to Celebrate the Health Care Bill… Sort of”
Well said. Re: interstate competition there actually IS an element of interstate competition inserted into the bill by Ron Wyden as part of the final compromise measures. The big sticking point – and the reason conservatives have backed this idea so enthusiastically – is the state mandates. Interstate competition sounds great until you realize that progressive states like Vermont will then be offered health plans based in reactionary states like Idaho or Mississippi. So if Mississippi doesn't require health plans to cover, say, mammograms and Massachusetts does, an interstate competition plan would drive the costlier Massachusetts plan (costly because it covers expensive things like mammograms that Massachusetts voters think health plans should be required to cover) out of business. The answer is to take the strongest mandate states – like Massachusetts – and write those mandates into Federal law. THEN open it all up to interstate competition. But that would require conservatives to show their cards…
Tort reform was kicked down the road to state experimentation. Tort reform is largely a conservative red herring, however. Texas passed draconian tort reform and while it did drive down medmal premiums it had zero impact on overall health care costs. But hey, if the AMA can agree to an examination board with teeth that would actually punish and defrock (or whatever the verb is) genuinely bad doctors then I'm all for Texas-style tort reform nationwide. Either regulate or litigate. If litigation is too cumbersome then come up with a regulatory mechanism that actually works.
If useful changes could be made to bad legislation, then we wouldn't have had a need for reform. The elimination of mandates is a good thing, because much of what is added is added as a payoff to the medical lobbyists that want to drive up costs in their favor.
Don't worry too much about it though: everything else that the industry lobbyists didn't want has been eliminated, so I'm sure interstate competition will get thrown out also.
Thanks Jazz, I think you put a good layer of lipstick on this pig. Both Dems and Reps should change their names to the OINK party.
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Best “cliff's notes” I've seen on this hog of a bill, Jazz.
Well done!
Is the bill doing enough to control costs? Check out this video:
whatstherealcost.org/45secondstoshare
I'm just happy to see all the Republicans stepping up to try to solve the country's common problem. Your attempts at working out compromises really demonstrates how dedicated you are to the US populace. I know the private health industry appreciates how much you've contributed to their cause.
May you stay healthy and employed.
Regardless of how much there is still left to improve, dilute, adjust, amend, negotiate–in Conference or not–, fine-tune, compromise, adjust, appeal, pundit, modify, demonize, work-on, revise, finalize. Monday-morning quarterback, “sour-grape,” recriminate, etc., etc. health care reform is going to finally become a reality, not for my benefit, but for the benefit of millions of less fortunate Americans in the most advanced, powerful, and wealthy country on this planet, in spite of decades of procrastination, indifference and obstruction by the Grand Old Party.
Merry Christmas, you all.
It's the lib Dems that have ruined and wrecked their effort, themselves, by overerreach and worse.
Still, they (or at least the more grown-up of them) need to view this the right way, with the correct reference — to nothing, because that's the point from where they started. (It may be a bit of a stretch for them right now to make them realize they have nowhere to go but “forward” from there, in years to come)
And, while the trend is toward less, still, at the end, the House conferencees still have the chance to press for more, before they're all through with this. (It's unlikely now, but don't be surprised if there is a revival of the public option, even if it comes back with some other name.)
This isn't over yet. And already you're past zero, despite your own self-made failures, so be relieved.