Why I’m supporting the Senate HCR bill

The Senate bill isn’t perfect.  It builds upon many things in our system that we’d do better simply doing away with.  It isn’t as fiscally sound as many would like, and I’m not at all sure that many of the more fiscally responsible measures in it will ever end up being enacted.  Such is the nature of our Congress.  When it comes time to make the hard choices they’re often kicked down the road.  Unlike Wyden-Bennett, it doesn’t cover 99% of Americans while paying for itself.  It neither creates the large cost-sharing pools I’d like to see, or spurs enough competition to make up for the lack of these larger pools (or pool).  And while single-payer would probably be more efficient (especially if you think of health insurance as an operating system, which in many ways it is) we’ll likely never get either to single-payer or to a real free market solution anytime soon.  We will be plagued with imperfection and compromise because that’s the nature of the beast, and the beast, dear reader, is here to stay.

But this compromise expands coverage to millions of Americans who didn’t have insurance before.  Many of these people are low income and have been denied based on their perceived risk – meaning that many are also sick or older (but too young for Medicare).  Getting these people covered is undeniably good.  Ending preexisting condition requirements which prevent millions of people from getting health coverage is also good.  And helping people pay for insurance that is beyond their means, in a more transparent exchange is also, in my book, undeniably good.

Most importantly, I think the creation of an exchange opens the door to moving toward a system more akin to the German model of healthcare, and the tax on “Cadillac plans” opens the door to shifting benefits from employment and making health insurance personal and portable.  We’re not nearly close enough to this, but these reforms (along with the individual mandate) put us on that trajectory and clear the road to changing the system in the future.  Failing to reform now almost ensures that reform doesn’t happen.  Period.  Certainly nothing indicates that if the GOP gains control of Congress or the Oval Office they’d do anything at all to alter the status quo.  And I’m not sure the Democrats will have the political capital to try again at least anytime soon.

This reform bill isn’t perfect or anywhere near perfect but it’s a start, and I hope it passes.  I think it will be good for America and good for Americans who currently face an uncertain economy and the very real risk of catastrophic illness and all that entails.

(If you want to know what will happen right away if this bill passes, read this [pdf].)