veiled4allah veiled4allah: Healthcare reform: 99% of the way there

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Healthcare reform: 99% of the way there

Date: September 09, 2009 | 18 Ramadan 1430 Hijriah
Blog: veiled4allah
Subjects: healthcare, congress, obama, politics
[Max Baucus's bill] really will be the most important progressive policy passed since Lyndon Johnson. - Ezra Klein
Five committees in Congress have jurisdiction over healthcare reform, three in the House of Representatives and two in the Senate. Before Congress rose for its summer recess in August, four of the five committees had passed fundamentally similar healthcare reform bills. Yesterday, the final committee, the Senate Finance Committee lead by Montana Democrat Max Baucus, introduced its own bill. It has not yet passed it, but is beginning the process of debating and voting on it.

With the Baucus draft bill, Democrats in Congress agree in principle on 99% of what Obama wants in healthcare reform. In its current format, the Baucus draft bill would enact about 95% to 97% of what Obama campaigned on. This is a huge victory for Obama and for Democrats if only we have the wit to see it.

The healthcare reform package that Obama campaign on includes the following among its most notable elements:

  • Regulation of insurance companies including preventing them from dropping people or reducing their coverage because of a pre-existing condition
  • Expansion of coverage to most of the current uninsured, primarily through expansions to Medicaid, Medicare, and other existing government programs
  • Make health insurance more affordable through a variety of cost-cutting measures within healthcare as well as subsidies and tax credits for working families
  • Require employers to provide health insurance for their employees or face a fine
  • Establishment of healthcare exchanges where (some) individuals and businesses can choose a health insurance plan from among a menu of options, increasing competition
  • Creation of a "public option", a government run health insurance program available on the exchanges
The Baucus draft bill provides for all of these except the last item (the public option). Per the analysis by Ezra Klein, it is unfortunately weak on the employer mandate and on the healthcare exchanges, but it does include these elements. It is on this basis that I say that all of the Congressional committees agree in principle on 99% of what Obama wants (everything but the public option) and that if the Baucus version is enacted it will provide about 95% to 97% of what Obama wants (minus the weakness in the employer mandate and exchanges, and minus the public option).

If you think about it, this is an amazing achievement. Every Democratic president since Harry Truman has tried to pass universal healthcare. The most successful was Lyndon Johnson, but Medicare and Medicaid only cover a relatively small portion of the population. Yet not only does Obama look to be on the verge of succeeding where so many before him have failed, but he looks likely to get it through Congress in nearly the exact form he proposed it. That's one for the history books, folks!

Even if the Baucus draft bill is the final version that is enacted - without the public plan - it will be a huge improvement for this country, not only for the 47 million uninsured, but also for the majority of us who do already have health insurance. As Ezra Klein notes:

The legislation really would protect millions of Americans from medical bankruptcy. It really would insure tens of millions of people. It really will curb the worst practices of the private insurance industry. It really will expand Medicaid and transform it from a mish-mash of state regulation into a dependable benefit. It really will lay down out-of-pocket caps which are a lot better than anything people have today. It really will help primary care providers, and it really will make hospitals more transparent, and it really will be a step towards paying for quality rather than volume.
I absolutely and without reservation support passing the Baucus bill. We cannot let the perfect be the enemy of the good and continue to suffer under a broken system because we are too proud to accept a partial reform. It will be a lot more than "half a loaf". In fact, it will be most everything we want.

Unfortunately, many progressives seem to have made the public option the sine qua non of healthcare reform. It isn't. It does not by itself regulate insurance companies in any way. It is not the element that is primarily responsible for covering most of the uninsured (that's the Medicaid and Medicare expansions). A healthcare reform bill without it will do nearly everything for people today that a bill with it will do. Yet to hear many progressives talk, you would think it alone is the only true element - oh, and it will give everybody a pony too!

Read Ezra Klein (different post; he is the one indispensible blogger on this issue) and Nate Silver for a reality check.

The fact is, the flaws in the Baucus draft bill in regard to the employer mandate and the exchanges are the kind of things that can and likely will be resolved in negotiations, either within the Senate Democratic caucus, or between the House and the Senate. Everybody agrees in principle that these elements must be included, the only dispute is over the details.

Which leaves the public option as the one issue left to be resolved (think about this for a minute - if someone had told you a year ago that Congressional Democrats would all agree on those health insurance regulations, would you have believed them? Yet they do). Republican Senator Olympia Snowe of Maine has proposed a compromise solution, a "trigger" under which if insurance companies do not reduce costs and increase coverage within a few years, the public option will be created. Read Nate Silver on why this may be the most progressive course.

Snowe's trigger option may yet be added as the Finance Committee considers the Baucus draft bill. Or it might be added as the Senate Democratic caucus decides what bill to take to the floor. Or it might be added during the conference between the House and the Senate to resolve differences between their bills.

If this compromise does get enacted, I think we will have about 99.5% of what we want. I'll take it. Will you?
~ Posted by Al-Muhajabah, a member of the reality-based community, at 06:04 AM

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