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].)
For my rebuttal please just read Megan McArdle’s post here:
http://meganmcardle.theatlantic.com/archives/2009/12/the_process_of_passing_health.php
This bill is a stinking turd and it won’t get any better.Report
Oh come on. You can do better than that.Report
They basically passed a crappy bill that they are on record as just saying, “Oh we will fix it later.”
That’s not how the process is supposed to work.Report
Pray tell – how is the process supposed to work?Report
P.S. – Megan is referencing one very specific part of the bill that cannot be changed and either way that language will almost certainly be stripped from the final thing. She’s taking one very specific thing and trying to apply it to the entire bill, as though the bill itself will then somehow be impossible to reform or change down the road. That’s simply not true and it’s one of her sillier arguments.Report
Wait, how do you know that language will get stripped out of the final bill?Report
Did I say that I know that?Report
But there are plenty of acknowledged flaws in the bill. Legislators should not be passing flawed legislation. If it’s broke – fix it first.Report
Mike – are you kidding? Can you honestly say that with a straight face?Report
Absolutely. This was a rush-job and it would have gone much smoother if they had tried to be less-comprehensive. By tacking on the entire liberal wish-list they ended up with a disaster of a bill. Howard Dean was right – they should have started over or at least went back to the House bill. This is going to go through for one reason only: the arbitrary deadline of getting it passed by Christmas.Report
I disagree with E.D. on the merits of this bill, and think it makes things worse rather than better, but one thing I would not call it is a rush job. To be perfectly honest, I suspect that if the Dems had tried to ram it through more quickly, it would have wound up being better legislation, less captured by interest groups.Report
You may be right, Mark. I’ve thought the same thing myself. But that wouldn’t be the case the second time around, I’m afraid.Report
Not if you uncomplicate the bill. Break out the separate policy proposals. Smaller bills are sometimes more immune to special interest because the public can more easily digest the subject matter and congressmen don’t have to depend on lobbyists to explain the bill to them.Report
The trouble with smaller bills is that they’re also far less likely to capture the public’s attention at all – or as important, the media’s. This means that legislators have to rely even more on interest groups as sources of information, which will tend to increase rather than decrease capture.Report
That’s disingenuous Mike. If the Dems had broken the bill up into parts then the Republicans would have simply bogged the first part down just about as much as they did the current comprehensive bill. If you need to ram a bill through the process against a minority that is blatantly interested only in obstructing and delaying the bill for political purposes then it’s better to do it all at once than bit by bit. So if the Dems had done it in pieces we’d be where we are now roughly, but with no bill at all and Republicans would be crowing about how they haven’t gotten anything done.
The bill sucks. But considering the process it had to go through it’s no wonder.Report
But how much of the bill do Republicans really oppose? They don’t like the public plan. They don’t like federal funding of abortion. There’s a couple other points. But on a big chunk of the bill there is probably agreement.
And if you’re right that the GOP would oppose every little chunk of the bill on partisan grounds then breaking the bill up would expose that.Report
It may expose it. But no one will care come election time so there’s no upside for the Dems. I’ve not seen anyone get seriously punished for obstructionism in American politics. the right wing base will like it fine and the moderates won’t care.
The thing is that beyond the politics the Dems actually want to get something done. If that’s your priority then the big honking bill is the correct method considering the oppositions position. You’d only run it through in parts if you thought the GOP was going to actually bargain in good faith.Report
“By tacking on the entire liberal wish-list they ended up with a disaster of a bill.”
Mike, you must be joking. The entire wish-list, at least this liberals wish-list, is single payer. I’m sure you have heard the expression about snowball in hell.
Please hold down the wild talk, leave it to Bob Cheeks.Report
It isn’t a rush-job, it is a bill that got sand-bagged by senate rules and intractable opposition. Any bill going through the senate on this issue was going to get this treatment. We have been going at this since before august.
A beaten-up bill, changes to senate rules(I’ll hold for your laughter), or nothing were always the only options with the senate we actually have. I know you wanted nothing mike, but the complaining about the Frankenstein-like nature of the final product by the people who made it necessarily more ugly really grinds my gears.
If republicans had never threatened to fillibuster then lieberman and his cohort could not have mangled the bill into a form most would change. But that isn’t what happened, the republicans used their legitimate by senate rules options and that led to the mangling of the bill.
Mike it is ok to say you just don’t like the entire concept of the bill without dressing it up with irrelevancies.Report
Is there ever anything other than flawed legislation?Report
Agreed. It’s a disaster. There is no way I’ll support it.Report
At what point in the debate were you leaning to supporting any bill likely passed by a democratic majority with a democratic president?Report
I don’t know how you make your decisions, but I do it based on the merits of an issue and my principles and conscience, not on partisanship.Report
In other words, never…Report
There’s nothing like a series of assertions with no evidentiary backing to get me to change my mind!Report
Welcome to Romania, East German, or the Soviet Union circa 1952. It would be much better if we were to engage in a sanguinary revolution than to nationalize medicine.
I think people forget the concept of liberty, the culture atrophies, becomes complacent and dependent then demands that it’s physical needs be met by the state. In the end it’s human nature really. The result of Original Sin, or rather the cost of it.
It’s a shame really.
In the end, all that good men can do is resist!Report
The existence of – say – Denmark, Sweden, France, and so on and so forth make your use of Romania, East Germany, etc. rather moot and quite honestly a bit silly. But that’s neither here nor there.Report
E.D. I really hope, sans snark, that neither you or your family fail to get prompt and good health care when you need it. I hope that you and your loved ones are not forced to endure death or suffering because of the inept bureaucracies of the state.
But only time will tell.Report
Bob, the one time that my family did need healthcare very badly and were very nearly stranded without, the inept bureaucracies of the state provided. It was a huge relief and I am thankful for it every day.Report
E.D., actually I’m happy to hear that. Sadly, that’s going to be the way it is for everyone, except Senators and Congressmen who are exempt from this whore’s nightmare, from now on.
I’m all for “health care reform” but having the commie-Dems write it is absurd. This particular bill is a disgrace on several levels and I think you know it too.
Why not join with us in trying to stop it and rewrite reform legislation that might actually work? Why are you, a “centrist”, so eager to get this done? Your behavior is reminiscent of a wacky socialist, rather than a level headed “moderate”!Report
This particular bill is a disgrace on several levels and I think you know it too.
Why not join with us in trying to stop it and rewrite reform legislation that might actually work?
Because like I said, I don’t think we’re going to do better. Not with the filibuster in play. And I don’t think the GOP has any will whatsoever to make this an issue and do anything about it.
If that makes me a wacky socialist so be it. I’m not really concerned anymore with those labels or with being called a centrist or a statist or anything else.Report
ED, I sense tension here!
Calm down, you’re loved, we just don’t agree with you on this issue!
BTW, a few years from now, after gummint “health care” works it’s magic and you’re not happy or you and your yuppie friends have suffered greatly, will you post something about that old guy (Cheeks) who used to bitch about the socialists/commie-dems? I’d appreciate it.Report
Sure, Bob. But I’m not sure we’ll know one way or another for longer than a few years.Report
Is there any kind of benchmark possible that could get us to say “okay, we shouldn’t have done this, let’s go back to the old way”?
Anything at all, even in theory?Report
Sure thing, when the good ‘ol US of A turns into “…Romania, East German[y], or the Soviet Union circa 1952.”
Courtesy Bob Cheeks.Report
This would be more persuasive to me if the United States didn’t compare so pitiably to other OECD countries when it comes to wait times. We already have inept bureaucracies forcing long wait times in this country. The current HCR bill actually streamlines some of those processes in ways that the health insurance industry has been resistant to do.Report
Don’t look to Europe for a model we should follow:
http://www.heritage.org/Research/HealthCare/HL711.cfm
More later if I get a chance.Report
For funsies, see if you can find a cogent counter-point to the heritage foundations perspective on european health-care. I’m sure you can find at least one instance of a sober analysis by sensible people who end up disagreeing with you due to a different perspective. I mean europe and liberals aren’t crazy-commies all the way down.Report
Have at it. Find one.Report
Here’s one from our own Mark Thompson. He and I have both cited the Heritage Foundation’s own Index of Economic Freedom often to illustrate the point that Europe is not in fact some socialist hell-hole. So in some sense this is a way to argue against the Heritage Foundation by using the Heritage Foundation.Report
The point wasn’t for me to do it, the point was for you to branch out of your idealogical cocoon.Report
As a matter of philosophy, I’m far from happy with the bill heading towards passage in the Senate. As a matter of public policy, I support it, because, frustrating as it is to admit it, I’m not sure how likely it ever could have been to get any reform that was any different. In the end, the choice is between this, and the status quo. A crummy choice, but not, ultimately, an especially difficult one.Report
Very true, Russell. A crummy choice but not a terribly hard one.Report
Arben!!!!!!!! Do you know what’s in the bill???????????? Well, then please tells us!
Isn’t that the point…no one knows what’s in this abortion and YOU PEOPLE are recommending we quietly accept it! Pleezzzzzzzzzzzzzzze!
To the barricades!Report
Mike:
I think that has already been pretty well exposed. Or do you not watch/read/listen to the news?Report
It’s a 2,000 page bill ED. What % of that have Republicans really opposed?Report
I fail to understand the question. So what if it’s a long bill? We got to the bill we have largely because of compromises first attempting to woo Republicans and then moderate/conservative Dems. Republicans will still filibuster this bill. They oppose 100% of it as far as I can tell, whether it’s 20 or 2000 pages. What’s your point?Report
Can you tell me what the Republican position is on Sec(s) 2251 and 2252?Report
Their position is opposed. They have stated as much. Their goal; to roadblock whatever the Dems attempt to enact in order to prevent the left from obtaining any accomplishments on this front.Report
So they have a stated position on those two specific sections? Please share.Report
What exactly is your point, Mike? They are opposing the entire bill including every section in it.Report
No – they are opposing the bill based on some of the provisions. That is what happens when you over-complicate legislation. If we created a huge bill tomorrow that did all sorts of wonderful things but had one small provision tucked into that all blogs will be subject to a new blog tax… something tells me you would oppose the bill.
The point I am trying to illustrate in what I thought was an obvious way is when you and others color Republican opposition as all-encompassing and simply no for the sake of no…that isn’t exactly fair. There is plenty in the bill that Republicans would probably have no problem with. So again, why not take out the bad, pass the 90% that is good with bipartisan support and then have real debates about the remaining 10% that causes real friction?Report
Once more with feeling:
It is not the business of the Republican caucus to assist the Democratic caucus in making and vending sh*t sandwiches. It is the business of the Republican caucus to advance….their own proposals.Report
Erik,
I think David Brooks ( http://www.nytimes.com/2009/12/18/opinion/18brooks.html?_r=1) and David Frum (http://www.frumforum.com/why-health-care-bill-is-too-big-a-risk) have made the best cases on the health care bill. I do want to see reform, but I don’t know if this is the right kind of reform. What I have learned over time is that creating a federal program is “easy” reforming them is quite harder to do.
I might be wrong on this, but I am wary of the current bill.Report
You are right Dennis. I believe this bill creates over 20 new federal agencies. And that is supposed to reduce costs how?Report
The best point Brooks makes:
“Consumers are insulated from the costs of their decisions…If this bill passes, you’ll have 500 experts in Washington trying to hold down costs and 300 million Americans with the same old incentives to get more and more care.”
This circles back to the point I made the other day that we have to put the consumers more in-touch with the true costs of their medical decisions. I am lucky enough to work for a company with fantastic health benefits. I see my coworkers regularly abuse that system for a host of ridiculous reasons. (I also think that the insulation between true costs and the consumer is at least partially to blame for a nation of over-protective mothers who rush to the pediatrician every time their kid sneezes, but maybe that is fodder for another conversation.)Report
I’m speechless. I won’t likely be alive 20 years from now, but, in this respect, if this rotten salmagundi passes, I feel sorry for those of you who will be. Remember, when you had a chance to take a stand, you laid down.Report
Er, I stood up. I want a health bill.Report
Will this bill make it easier to practice as a doctor, more difficult, or no change?
Will this bill make it easier to practice as a nurse, more difficult, or no change?
Will this bill make it easier to introduce new medical technology, more difficult, or no change?
Because if the answer to all of the above is a mix of “no change” and “more difficult”, what we’ve got here is a bill that will slow the rate of increase of supply of medical care at the same time as creating more demand during a period where people were complaining about the price in the first place.Report
Mike and JB, excellent! This bill is bs, if it wasn’t the pig-congressmen would gloom on and suck it dry…you’ll notice these bastards don’t, they keep their own insurance!
So, boys the fight ain’t over! They haven’t won yet!Report
Erik,
I think David Brooks ( http://www.nytimes.com/2009/12/18/opinion/18brooks.html?_r=1) and David Frum (http://www.frumforum.com/why-health-care-bill-is-too-big-a-risk) have made the best cases on the health care bill. I do want to see reform, but I don’t know if this is the right kind of reform. What I have learned over time is that creating a federal program is “easy” reforming them is quite harder to do.
I might be wrong on this, but I am wary of the current bill.Report
When there is a menacing beast around, sensible people defend themselves. They get their weapons and try to kill it. They don’t cozy up to it hoping it will change its nature.
Remember the story of the scorpion and the frog. The scorpion persuades the frog to take him across the river on his back and promises not to sting him. But, halfway acrss, the scorpion can’t fight his nature and stings anyway. They both drown. Let’s not be frogs. Let’s see the scorpion for what he is and stay away from him and out of deep water!
This Senate bill is a disgrace. The Senate leadership is making special concessions and throwing around money on monumental scales. This isn’t normal compromise. It is unacceptable tainting of our already questionable legislative process: http://www.washingtonexaminer.com/politics/Big-payoffs-to-senators-on-health-bill-stokes-public-anger-8675288-79940092.html.Report
The problems this bill creates are problems we are going to face anyway. The bill puts us in a better position to address them. Most importantly, it is a rejection of the status quo. After this is passed, no one is going to say we need to go back to the system before Obamacare. I think this is the biggest miscalculation the GOP has made. The actual reforms: 1) creating a real market for individual insurance; 2) insuring the sick can receive coverage; and 3) subsidizing those unable to afford insurance on their own are widely popular, even if the bill in toto is not. Needless to say, I have faith those views will persist versus the current anxieties over this bill.Report
E.D., you went ahead and wrote that piece I was going to look for a guest author to contribute! I`m glad it ended up coming from you after all. There are obviously .many ways this thing could be much, much better (though good luck getting people to agree what those are) — not least starting with a whole different approach altogether. But a point you made above in comments is key: without two parties competing full-out to offer the best solutions anyone can think of to this crow`s nest of problems, the was an approximately zero probability of our arriving at one of the more-better combinations of measures rather than one that left a great deal to be desired.Report