The papers were filled with headlines on Saturday that the House passed a comprehensive health care bill, by a narrow 220-215 margin. Predictably, only one Republican voted for it, and he will be gone soon, as he holds a historically Democratic seat in Louisiana.
The action now shifts to the Senate, where the two main committee bills are still being reconciled, and then the reconciled bill will be presented and filibustered. Joe Lieberman has already announced that he will filibuster any bill with a public option in it — other Democrats might as well — assuring that such a bill cannot get the 60 votes needed to bring it to a vote. Because of the overuse of fillibusters, the minority rules in the Senate blocking any hope for a public option.
So will we get a bill? My magic eight ball still says “yes,” but it is now possible that the reform effort will collapse under the weight of narrow self-seeking by legislators. They don’t always — civil rights legislation was famous for legislators voting their consciences. Any final reform will still have excellent features — no denial for pre-existing conditions, no lifetime cap on expenditures, and no denial of existing coverage even if you have a major illness.
Health-care reform is good economics: not because it will create jobs now — but for long term economic gain. Universal health care and restrictions on insurance companies’ ability to deny coverage will reduce administration, unlock people so they can change jobs regardless of health care coverage, and reduce the federal deficit.
It is promising that the Obama Adminstration has made deals with Pharma, hospitals, doctors, and seniors — last week, the AMA and AARP both endorsed reform. Insurance companies are against it and it always looked like the insurance companies would be the bad guys. This is a role they have embraced with a tricked-up and misleading “study” that overstated the costs of reform while ignoring any benefits. And old-fashioned horse trading could kill health care reform. Thirty-nine House Democrats voted “no.” Anti-abortion Democrats forced a regressive provision on choice into the House bill, while individual Senators are cutting deals for special favors: Medicare spending increases, foster parent help, etc.
Legislation is a sausage factory, to be sure, but too much deal making can erode votes for passage: Members see deals being made and think, “Why not me?” Eventually, the whole edifice can collapse. That may happen with health reform — let’s hope not. But it is a sorry commentary on how hard it is to actually enact major social legislation in the U.S., even when the Kaiser poll has shown as recently as October that over half of Americans think health-care reform should pass now and everyone should have access.
15 Responses to What Now for Health Care?
kffdn - November 9, 2009 at 11:54 am
“Health-care reform is good economics.”What a laughable line. Thank God for people like Joe Liebermann, one of the few laudably “voting their consciences.” I’m glad at least some legislators don’t want to saddle us with crushing costs en route to greater statism.
suomynona - November 9, 2009 at 10:05 pm
And by ‘voting their consciences’ kffdn means blocking a vote in which people would then have the opportunity to vote their consciences.
macheath - November 9, 2009 at 10:39 pm
Ghilarducci is far too kind to legislators like Joe Lieberman, who is one of the biggest egomanical gasbags in a Senate filled with them. Lieberman pontificated for months about how he was concerned about health reform’s effect on the deficit. Guess what? The Congressional Budget Office scores both the Senate and House efforts as reducing the deficit. Did old windy Joe change his mind with the facts? Nope. Now he’s a bogus “profile in courage,” STILL saying that he is opposed because of alleged impacts on the deficit, even though the bills would reduce it. And suomynona has it just right. Lieberman and others are refusing to let the bill come to a majority vote. They can vote against it if they like, and try and get 51 against. But the Congress, and democracy, wasn’t designed to require supermajorities to pass bills. This is the same disease that California has enshrined in its constiution, requiring a 2/3 majority for raising taxes, with the resulting paralysis and disfunction we now see there. In the US Senate, it is just nay-sayers who posture with philosophy, while denying democracy.
livefreeordie2 - November 10, 2009 at 7:10 am
This is a load of crap. The link to “excellent features” goes to a Washington Post article that has a completely different thrust. Your accusation that insurance companies produced a “tricked-up and misleading study” is linked to a Rolling Stone article. And of course, you finish up with absolute nonsense based on one poll – not from a polling organization – and you’ve blatantly mischaracterized that! In fact, it’s almost a lie. The article on the Kaiser web site says that “Fifty-five percent of Americans believe that it is more important than ever to take on health care reform now.” “Take on” is different that “pass now.” Your wording would indicate that 55% support for the house bill that just squeaked by. That is not what it said and not what other polls indicate. Why not quote the most recent Gallup poll? It says that only 29 percent would advise their members of congress to vote for a new health care bill this year. It also says that 54% think the house bill will make health care in America worse or not much different.Here’s the thing. . . you are entitled to your opinion. If you want to believe that the vast majority of Americans want to see the health care system destoyed, you are entitled to that fantasy, however perverse it may be. But don’t change words around to make it look like it’s more than just your opinion. If anyone has produced something that is “tricked-up and misleading,” it would be you.
swygant - November 10, 2009 at 12:22 pm
Kudos to livefreeordie2 for pointing out the inaccuracies and distortions in this story, which is typical of the mindset of those pushing this particular version of “health-care reform”. Even if 55% of Americans do want the Congress to take on health care reform that does not equate to passing this horrendous piece of legislation, or supporting any of the specific proposals contained in it. There are plenty of ways to move towards reforming our health care system that do not compromise basic personal and economic freedoms or further throttle our economy in the ways that this bill does.
hafajc - November 10, 2009 at 12:25 pm
“Predictably, only one Republican voted for it, and he will be gone soon, as he holds a historically Democratic seat in Louisiana.”How about “Predictably, those Democrats who oppose the bill were blackmailed and threatened into voting for it?”Hmmm.Predictably, the author of this article cites dogma, and is hampered in no way by any truth. The ends justify the means, don’t they? Seems like I recall reading about that position somewhere in the distant past. Perhaps you (the author) should admit your bias. But your GroupThink mind does not see it as ‘bias,’ it is just a universal truth, isn’t it? You cite one ‘poll’ where you say the American people support healthcare reform, and conveniently ignore the facts.But let’s face it–it is ‘cool’ to be an Obamaphile, isnt it? Let us all march lockstep towards our nanny-state, eliminate the evils of capitalism, sing cumbaya, and remember those great days in the 60′s and 70′s when we all sat around at SDS meetings, planning to take over ‘from within the system.’ “Power to the people” (in the government).
cwinton - November 10, 2009 at 12:40 pm
Those so enamored with our current health care “system” need to explain to me what is so great about it. Like almost everyone I know, I am constantly mystified by the musical chairs game of co-pays and supplemental bills I have to shell out every single time I submit myself to our health care “system”, and I have what is considered to be a good health insurance plan. The paperwork alone has to require a bureaucracy rivaling the worst of government agencies. It may be that the “reforms” just passed will be no improvement, but at least someone is trying to address the common good, which the current “system” definitely does not.
dank48 - November 10, 2009 at 1:26 pm
Granted, the current health-care situation is a mess. It does not follow that any health-care “reform” will improve the situation. It’s quite possible that it could make it worse. (Less likely that it would leave things more or less as screwed up as they are now, but possible.)What mystifies me is the notion that, if a given proposed solution or reform or initiative or whatever they call it is in fact so wonderful that we should all be down on our knees giving thanks, it has to be mandatory. Why make health-care “salvation” mandatory? If the new system is truly better, it will win through on its own merits. If in fact people wouldn’t like it better than what they already had, forcing it down their throats won’t make it more palatable.It has been pointed out before that when the automobile came along, it was not felt to be necessary to pass laws against horses. Any mandatory or compulsory program is just more of the same old crap foisted on the rest of us by a we-know-what’s-best-for-you Congress that doesn’t have to live with what they’re imposing on everyone else. If Congress gave a damn about us peasants, we would all have the same health-care program Congress enjoys. Don’t hold your breath.
rhetoric - November 10, 2009 at 5:36 pm
A military budget bill was just recently passed (quite easily, mind you) to the tune of 680 billion dollars a year. The silence from the decriers of the “nanny state” is ironic enough to be palpable. Perhaps they are annoyed with the fact that the proposed health care plan will cost just a few more billion than what we currently pay for our public education?
suomynona - November 10, 2009 at 8:21 pm
hafajc,You write about GroupThink, but your post is so full of buzzwords (nanny-state, march lockstep, sing Cumbaya) that it makes quite clear who is engaging in the mindless ‘thinking’ of a collectivist movement.
livefreeordie2 - November 10, 2009 at 10:00 pm
rhetoric – Gee whiz. . . golly. . . hate to do it, sport, but let me refer you to this tiny, little document called the US Constitution. There’s all this really silly language about raising and supporting Armies, requiring the government to provide and maintain a Navy, but you know what? There’s not a thing in there about health care! Shocking, isn’t it? But true. So for those who understand how this government was formed and what it is supposed to do, of course there would be silence about the Congress doing what is required. And of course there is outrage when it tries to do what is none of its business.As for cwinton, you clearly have no idea how bad it can be under a socialized medicine scheme, do you? Besides, the current argument isn’t about quality of health care because we have the best in the world. And it isn’t about access, because anyone can walk into an emergency department and be seen – it’s against the law for them to ask for insurance or money. So. . . what’s it about?Is it about cost? Then let’s have some tort reform! That is the one really big area where money is wasted. Is it about the uninsured? Well, 85% of the population have insurance. If that is really the problem, then why not have the government pay for insurance for those who need it? Or put them on Medicare or Medicaid? Why change the system for everyone? CONTROL!Once the government is responsible for everyone’s healthcare, then it can claim a vested interest in everything you are, everywhere you go, everything you do. The loss of freedom for the American people will be spectacular and unprecedented. And it will be done in the name of “controlling health care costs.” Are you a ski bum? Do you like good food? Do you drink? Any behavior that can be shown to affect your health – real or imagined – becomes an interest to the government. And for those of you that think “death panels” are just silly conservative nonsense, think again. As I’ve posted elsewhere, the government already makes treatment choices based on a patient’s age. If the house version of “health care” ever became law, within 10 years, this would be a very different America. The current system is far from perfect, but I’ve seen other systems. . .far from perfect, but it’s the best in the world. That’s why foreigners come here for treatment. And that is why we are “enamored” of it.
suomynona - November 11, 2009 at 8:04 am
livefree, the ignorance of your post above is boundless. 1) Re. the Constitution, might I remind you that it never was a complete document; that it contains 20something amendments, which include: abolition of slavery and the granting of women’s suffrage in the late 19th century, along with more recent and crucial modifications like limiting the presidency to two terms and establishing the national voting age of 18 in the mid-late 20th century. This is not to say that the Constitution ought to be ‘revised’ lightly, if at all. But that sometimes things come to light (like, say, recognizing that women ought to have the right to vote; or perhaps that all ought to have the right to basic health care) that require a Constitutional amendment. That’s why the amendment procedure was built into the Constitution, and why nothing happens to the Constitution, despite what paranoids suggest, outside of the parameters that the Constitution itself prescribes.2) The access problem and the cost problem in US healthcare are not separate issues, as you treat them. If that access problem is solved for you because ‘anyone can walk into the emergency room,’ as anyone without insurance does, this drives up costs tremendsouly, feeding the cost problem. There is a hell of a lot more to healthcare costs than malpractice litigation.3) There is no proposal to nationalize healthcare in this country whatsoever. There is likewise no proposal to force anyone who already has health insurance to forfeit it for some kind of government plan. How many times must this be stated before it penetrates the skulls of the obsinate? When you write “why not have the government pay for insurance for those who need it? Or put them on Medicare or Medicaid?,” this is exactly what Democrats have been trying to do, with Republicans digging their heels in the ground to prevent it. 4) If you think the government’s potential interest in our daily activities as they relate to healthcare could get any creepier or more bureaucratically particular and technical than what already exists with private insurers, you have another thing coming. Likewise if you think government rationing of care would be any worse than in the current ‘system,’ which is engineered and directly incentivized by the market to ration and deny care whenever possible, while increasingly shifting service costs onto the consumer.5) We have the best top-end healthcare in the world, but far from the best system. As I’ve said elsewhere, there’s a huge difference between the quality of our research and facilities and physicians (and physician training) and our healthcare delivery system. The two aren’t unrelated; but they aren’t the same thing. It’s one thing to rant and rave about how America will go down the toilet in 10 years–claims that divorced from objective reality cannot be proven nor denied by virtue of their removedness–but it’s another to get flat out wrong the facts right in front of our eyes.
livefreeordie2 - November 11, 2009 at 12:13 pm
suomynona – As I mentioned, you are certainly entitled to your point of view. But you are wrong.1. Of course the constitution has an amendment process. And it has 27 amendments, not “20 something,” a fact that I thought everyone learned in the 8th grade. And there is nothing in the US Constitution or any of its Amendments that speaks to the government providing health care. But your comments are irrelevant to the purpose of the posting, which was to answer rhetoric’s nonsense about military spending. That’s a requirement – health care spending is not. But you’ve swerved into an excellent idea. Someone should offer a constitutional amendment to make providing health care a responsibility like the military or the post office. Think it would pass? I don’t.2. Of course tort reform isn’t the only solution, but defensive medicine is a huge part of excess costs and that isn’t even being considered because the Democrats are in the pockets of the trial lawyers. And of course ED treatments are expensive. Makes you wonder why hospitals don’t just set up clinic to handle the non-emergency cases. Why? Because the government won’t reimburse them. There are tons of absolutely idiotic regulations that hospitals must abide by to get reimbursed for the treatment they provide and let me tell you, every hospital loses millions if not tens of millions for treatment they provide, but for which they are not reimbursed. 3. You are apparently living in some sort of static world. Here’s the real, dynamic world. The government provides health care coverage, and at the same time, stipulates the minimum coverage employers must provide. That minimum costs more than whatever tax penalty the employer must pay, in other words, the company saves money by no longer providing coverage. The company no longer provides coverage and people must either buy it on their own or go to the government plan. This is not hard to figure out. . . and it is precisely the plan that will push everyone onto the “public plan.”4. If you think that rationing can’t get worse, then you haven’t read anything about the Canadian system or the UK’s NHS. People wait months for simple diagnostic tests that we get immediately. People die from cancer or heart disease while on waiting lists for treatment. And I’ve got to tell you, this is the one contention that you’ve made that makes me angry. This isn’t a great unknown. Government run health care has been tried. It doesn’t work nearly as well as our imperfect system. It doesn’t reduce costs, all it does is reduce quality and service. 5. Name the country that has better health care. Again, it’s probably not your fault, but you really have no idea what you’re talking about. The government itself via the CMS (Centers for Medicare and Medicaid Services) publishes rules that hospitals and doctors must follow if they want to get any reimbursement at all – thousands of pages every year (Final Rules). It is extremely arcane and not only does it obstruct common sense solutions, it punishes them. If you want to get your information on health care reform from the DNC and believe it, then go for it – I mean, that’s apparently what you are doing. But don’t regurgitate Barry’s BS to me and suggest I’m obstinate. Read about the experiences of other countries with government run health care. Read about how the government already controls a substantial part of how health care is delivered. Get knowledgeable. And if you still think that we should have a health care system that serves the interests of social justice rather than continuously improving patient care, I’m sure Barry, Harry, and Nancy will give you a big sloppy kiss on the lips.
mxb22 - November 11, 2009 at 2:18 pm
Go for it, livefreeordie2. But let me offer what might be a more radical, if forlorn, analysis. Our problem is insurance itself. We have let it turn into a pay-it-all third party. In effect, we hand the insurance company (or the government) all our medical bills and tell them, Here, you pay them, and then we’ll pay you for paying them. That’s bound to be the most expensive way of financing health care. We have forgotten the original meaning of insurance: it’s to cover us for rare, catastrophic events that would otherwise break us. That’s the only way insurance can be affordable and effective. If you want it to pay for everything, it will cost everything and more. Here’s an analogy: What if somebody talked us into buying “food insurance”?–that is, insurance that paid all our grocery bills. “Food care” is surely as important as health care, isn’t it? We would go to the grocery store and take as much stuff as we want, then the grocery store would bill the food insurance company big bucks for its costs, then the food insurance company would bill our employer big bucks for food coverage, then our employer would have to take more money out of our paycheck (which deduction we never keep track of anyway) in order to pay for our costly food insurance. End result: we would eat more food than we need, and we would have the most expensive food in the world. Surely this is unsustainable Then the government would jump in and try to regulate the whole system because it was so expensive. And that regulation would add to the confusion, complexity, and dissatisfaction. When hosptials and doctors had to deal directly with patients (before the vast enlargement of employer-paid health insurance after WWII), health care cost much less. Trouble is, that simpler system didn’t produce enough income for the health care system so that it could make progress in research and treatment, which clearly it has done during the last thirty years when so much money has been pumped into it. So, what’s the solution, or, more realistically, what’s the future? We are so far into third party payment that we will never get out of it, and our health behavior is so self-destructive but so self-indulgent that we will never change it. Therefore, the government will purchase less health care because it’s so expensive (and the government is a cheapskate anyway), and more people will get more sick and die. Or else, as I said, the government will completely regulate the health care system to lower its costs and then try to completely control the unhealthy behavior of Americans (the chimera of “preventive medicine”). Ugly outcomes in either case. Count on this: Things will get worse before they get completely worse. But we all die anyway, right, so what’s the beef? At least under the current system we achieved some wondrous medical advances in Capitalist America, advances the rest of the world, as usual, has sponged off.
suomynona - November 15, 2009 at 9:24 am
livefree,1) Without giving away too much, I should note for you that I live in a European country (am an American citizen raised in the USA), so I actually have pretty extensive experience with both government health programs like the NHS and American insurance plans. So you’re quite wrong to suggest that I’m getting my information from ‘Barry’ (this name game is such a silly way to show ineffectual disrespect for the president of our country). It’s lousy, polemical bs to assume, anyway, that a government option for health insurance or any kind of substantive health reform is the equaivalent of adopting a UK or Canadian health model. Options in Germany, Austria, and Switzerland are far better, in my view. 2) Our Constitution indeed has twentysomething amendments, 27 being a twentysomething. Thanks, though, for making that incisive comment and assumption about whether I know this exact number or not, as though it’s relevant.3) In this ‘real, dynamic’ world that you so wonderfully illuminated for me, I would imagine (I can only imagine) that any health insurer that aspires to be a legitimate business would reevaluate and improve its approach and its services if it stood to loose its whole customer base to a public option. It’s called competition, and it goes on between public and private services in all sorts of ways already. 4) Again, there are all sorts of options between and beyond America’s health care ‘system’ and truly government run systems like the NHS. I’ve already named three that I admire. You’re oversimplifying almost to the point of disingenuousness. Somehow you’ve gone from ‘public insurance option’ to the stock insurance lobby talking point ‘government run healthcare.’ Don’t accuse me of getting all my info. from the DNC while you’re content to use crude buzzwords spoon-fed from the insurance industry’s hand. 5) When you ask me to name the country that has better health care than the US, you’re still conflating health, hospital, physician, etc. resources and system of delivery. There are ways of keeping private doctors and private insurance companies and private hospitals, without turning the entire system over to the government and having government set prices while still drastically improving and systematizing (yes, systematizing) our ineffective delivery ‘system.’ I’ve already named several countreis with better systems than ours. If you’re wealthy, there’s no better place in the world to go for care than the US; but so long as we fail to provide basic care for all and productive regulations on private companies (e.g. that people can’t be denied insurance for being sick, which is the entire purpose of insurance), we’re underacheiving catastrophically. When we have people who are productive members of society going bankrupt because of illness or accident, we’re failing majorly. And when employment determines insurance and thereby limits consumer chocie for doctors, insurance plans, companies, etc., we’re wasting opportunities. I don’t need to bicker over whether Germany has better healthare delivery than the US to see the significant flaws in our method that need to be addressed. 6) …and I didn’t see any Republicans in congress addressing these issues in their own bills. In fact, I must have missed something; there seemed not to be an RNC bill at all.