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:
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.