Thursday, December 17, 2009

Health Care: Time to Stop & Think About What's Next

Honestly, I'm exhausted right now. I'm tired. I'm drained. This health care fight has delighted me at times, infuriated me at times, and has left me fighting with just about everyone over everything.

So what exactly am I fighting for? Thank goodness Desert Beacon is here to remind me!

[S]top sweating the small stuff. OK, it's not small to you that there is no public option proposal in the Senate version of the legislation, and it's not small to you that there is no Medicare buy-in for those aged 55-64. Those were proposals (and reasonably good ones) intended to bring down the cost of health insurance plans sold by private corporations. They are not now and never were central to the health care reform legislation. While we got down in the weeds with public options and buy-ins we've not been focused on the essential feature of the proposals -- the subsidy levels for insurance premiums and the income standards attached thereto. If anything, we ought to be arguing about whether or not the standard 250% above our unrealistically low assigned poverty level is sufficient to assist most working families in this country. I'd like single-payer, but that was never in the cards; and, I'd have been pleased to get a public option included in the insurance exchange and/or Medicare buy-ins, but I'm not ready to toss the positive aspects of the current Senate bill out with the bathwater du jour.

Yep, she brings up some valid points that I remember discussing last week, back when the Medicare buy-in became the "conflict du jour". There are still worthy elements of the bill worth passing, such as the increased regulation and improved subsidies.

However, I must admit I'm still afraid of any type of individual mandate to buy insurance if there's no public option available on Day One of reform. As I was saying yesterday, this is simply bad policy because it forces the working poor and middle class to buy crappy HMOs that they really can't afford. And of course, this also makes it bad politics since Democrats will be taking ownership of the individual mandate.

But then again, would it really be better for us to throw it all down the drain, as some progressives are now suggesting? Is reconciliation the "magic bullet" that we really want? Again, I'll defer to Desert Beacon.

Third, nothing would please the Republicans in the Senate and their corporate masters quite so much as to have the liberal and moderate wings of the Democratic party do their work for them. It's been the GOP intention all along to scuttle any and all health care reform legislation. We can assume this is so because they've hewed to their Luntz Talking Points from the beginning: Government Takeovers, Rationed Care, Bew-row-crats in your health care. They carped about imaginary "Death Panels," and they've whined about "Killing Granny." However, it's reasonably obvious that the last thing they wanted was to directly address the insurance company practices (exclusion/rescission) that helped create the crisis in health care we face today. Instead of addressing specific issues, they've consistently resorted to generalities and fear-mongering. Instead of steadily working on the legislation, they've consistently stalled and obstructed any attempts at progress (witness the Gregg Memo). Tossing the package out now because it doesn't sate progressives' advocacy for single-payer/public option/Medicare buy-ins plays directly into GOP obstructionist hands.

Fourth, there are no cheap fixes. The much touted, and much misunderstood, reconciliation process in the Senate is not an option if we really want the insurance reform we say we do. [Emphasis mine.] Senator Dick Durbin (D-IL) explained, "reconciliation is a very spare and thin process with limited opportunities." Reconciliation applies only to the money parts of the bill; it would not serve to pass insurance reforms that are at the heart of regulating the insurance corporation practices as they abuse their exclusion and rescission clauses.

So there you have it. Reconciliation can be done, but with tight limits and requiring far more time. And since it already looks like this process (as it is now) will drag into 2010, do we really want to risk health care being drawn out even closer to the midterm elections? And do we want to complicate things further by trying to figure out what can be done with reconciliation and what can't?

Again, we face some tough choices in the next few days... So maybe it's best for us to wait and see what happens next. After all, we don't even know all of what's in this new bill yet!

Oh yeah, and we finally have some good news in House Democrats inserting themselves back into the debate by demanding Conference to merge the House & Senate bills. This is good for us, as this actually keeps the public option alive and kicking. After all, remember that the House version has a public option and that House progressives are refusing to support any final bill with no public option.

And getting back to the Senate, let's remember something else. As hard as I've been sometimes on Harry Reid, I still understand that he doesn't have an easy job here. Matt Yglesias explains.

I think it’s worth sparing a thought in this regard for the much-maligned Harry Reid. It seems like it was only three years ago that [Beltway pundit] Jacob Weisberg was explaining to people that Reid and Pelosi were so icky, liberal, and inept that Republicans could stay in power forever or something. And liberals have rarely found themselves hailing Reid’s leadership. But the fact of the matter is that there’s almost no precedent for the legislative mission he’s been asked to accomplish of turning 59 Democrats, one loosely Democrat-aligned Independent, and two slightly moderate Republicans into 60 votes for a package that’s simultaneously a dramatic expansion of the welfare state and a measure that reduces both short- and long-term deficits.

On top of the intrinsically difficult nature of the task, he’s facing a really ugly political situation back home. Since Beltway mores dictate that you can never hold a member of congress morally culpable for actions undertaken in the name of raw politically self-interest, it must have been very tempting for Reid to get distracted. But he’s stayed on point and focused, dealt with the timid members of his caucus, dealt with the ignorant members of his caucus, dealt with the egomaniacal members of his caucus, and dealt with the all-too-typical Senatorial combination of policy ignorance, egomania, and political cowardice among some members. For his troubles it looks like we’re going to get a bill that liberals feel churlish about at best. But it’s really an extraordinary achievement.

So let's remember this. All of this. The final bill that emerges won't be perfect, but we still have time to possibly improve it. The Senate still requires 60 votes to get this done, since reconciliation isn't the "easy backdoor process" that some progressives dream of it as. And no matter how good and/or bad the final bill is overall, there are some inherently good elements of it that need to become law ASAP (before the window on health care closes yet again on Capitol Hill).

So excuse me while I take a breather for a bit. I will be analyzing and investigating whatever is thrown out next as "today's official Senate health care bill", and I will do my best to be more careful before praising it or trashing it.

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