21 December 2009

The path to 60

Senate Overcomes Key Health Care Hurdle | TPMDC
By a vote of 60-40, the Senate agreed to end debate on a major package of health care amendments--and by doing so, signaled that the Democratic caucus is unified, and ready to pass a far-reaching reform bill straight down party lines.
Finally, health care reform is in the home stretch.

I've not written much about this lately because, frankly, I haven't had too many original insights. Also, it's been such a rapidly-moving target that it's difficult to take a position on a new proposal before it's dead and the senate has moves on to something else entirely. I still haven't much more to say than has been said many times elsewhere, but just for the record:

This is a great bill, and a historic accomplishment for the Democrats.

Am I disappointed? Yes. It's a flawed bill, and could have been much better. The process could have been better handled. Why Baucus was allowed to string out the Gang of Six negotiations so long is a mystery.  Why the White House didn't take a more active role will be long debated.  The politics were and are atrocious.  It's frustrating to see a republican caucus more dedicated to obstruction than to the national welfare.  It's frustrating to see douchebags like Lieberman and Nelson hold the whole thing hostage at the last minute.  On the other hand, it was pointed out that the whole thing was, in a way, made possible by the conservative Club for Growth.  When they targeted Arlen Specter for a primary, he became a Dem, without whom they would not have had 60 votes.  Isn't life funny?

I do wish that we had obtained a meaningful government-run insurance option, but I console that loss with the fact that we did get:
  • $880 Billion in subsidies for the vulnerable poor to obtain health insurance
  • About 95% of all Americans covered; not universal, but close
  • Great regulations on insurance companies' abuses: community rating, guaranteed issue, no recissions
  • Competitive marketplaces where insurers must compete against one another: the Exchanges
  • Fiscal responsibility: a deficit-reducing bill
  • A strengthened Medicare Commission
  • Payment reforms
If you'd made me this offer in 2006 I would have jumped at it.  It's a great start.  It's more than Clinton could do, and it's success where Carter, Kennedy, and Truman failed.  I can live with it, and support it enthusiastically.  And I'll also support improving it and modifying it as soon as President Obama's ink is dry on the final legislation. 

But I don't want to count my chickens just yet.  There's a conference committee to get through, and neither the House nor the Senate Dems can spare any more defections if the final bill is to pass.  Health care reform is still terribly tenuous, but it is at this point looking likely to pass.

And that's a great thing.


  1. Excellent post.

    I quite like the insightful comment about Arlen Specter -- payback can be a b*tch!

  2. 2 questions!

    one, do you have a good source to stay updated on what step this reform process is at?

    two, when you say 95% of americans will be covered...... covered with what (bearing in mind that medicaid is not actually insurance)? and is there a penalty for people that elect to stay uncovered?

  3. for anonymous:

    this is a pretty comprehensive web site for updates and information on reform. there will be penalties for most people who do not obtain coverage.


    for shadowfax:

    my sentiments exactly. let's hope this baby makes it out of conference committee in into the law books.

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  5. 880 BILLION? Holy sh*t!!!

    That's like get-a-second-job-to-pay-your-taxes numbers there, man.

  6. K,

    Bear in mind that more than half that $880 Billion is financed by savings from Medicare -- mostly the elimination of the grossly over-funded Medicare Advantage.

  7. www.firedoglake.com is doing a great job covering the progress of the house and senate bills.

    without a public option the mandate that everyone get coverage is nothing but a gift to the health insurance companies.

    i have family members in florida. since the insurors can use "community" ratings and there are lots of retirees there, they can expect their premiums to rise substantially.

    i'm disgusted with the rank obstructionism of the republicans, particularly mine - cornyn and hutchison. in all their years in d.c. neither made any effort to take action to help the poor and the uninsurable (due to pre-existing conditions) then fought reform like it was some horrible thing.

  8. I am annoyed with several things in each house's version but I am happy that it looks like we will get the proverbial foot in the door with this. Once benefits are given, it is VERY hard to take them away as much as the Republicans would love to. From here, step wise progress will hopefully be made by subsequent administrations.

  9. Anon 5:31

    This bill is more than a giveaway to the insurance companies -- specifically the new provisions which limit their administrative costs/profits to no more than 15% (I think) of total revenue. The bill is phrased conversely -- requiring that the medical loss ratio account for 85% of total expenditures. But it's a nice brake on insurance profits/expenses. It's also why the insurance lobby has flipped into outright opposition recently.


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