Health Care Reform Hit Parade: Senate Mix

by Karoli on November 23, 2009 · 6 comments

in News


Now that the big “debate the bill” vote is passed, we have a week for pundits on both sides of the aisle to misinform the public about what the future of the health care reform bill is. There are two tunes, one theme, and melodies underneath both. There’s an unsung chorus or two in there, too.

The Progressive Theme: Reconciliation

Progressives are pressing ahead with petitions, blog posts, and swarms to advance the idea that health care reform — or more specifically, the public option — should pass using the arcane and somewhat unrelated escape hatch of reconciliation to force a vote which requires only a majority to pass.

Proponents argue that reconciliation does an end run around the filibuster and takes the ball to the goal. And it does, in a strange, stripped-down way. Here are some examples of reconciliation legislation in the past:

  1. Bush Tax Cuts Because they were passed via the reconciliation process, they expire at the end of 2010. Not particularly helpful to health care reform to have provisional reform that is not permanent.
  2. COBRA the last attempt at health care reform that was ultimately diluted to something that screwed laid-off and terminated workers more than not having insurance at all.
  3. TEFRA – The Tax Reform Act of 1986 It had something for everyone, but again, no meaningful social legislation and certainly nothing that had a deeper impact than the bottom line of form 1040.
    It’s been suggested to me that the purpose of putting the full court press on reconciliation is to let Reid in on the worst-kept secret of our time: The public option matters to progressives and they believe it is the magic amulet to force insurers and providers to keep costs down. More rebuttal to that in my Unsung Chorus sections.

    I think pressure is good. I think engagement is good. What I don’t think is good: signalling desperation to one’s opponents. There are other, better ways to work this through the process.

    The Conservative Theme: Everyone hates health care reform

    This is the current media and pollster theme. Everyone hates it, it’s not popular, so Congress should drop it. I could argue with their logic or foundations for making a statement like this, but it would be a waste of time. Nevertheless, this will be what we will hear from now on — that we, the people do not want health care reform. That we really, really like being denied by insurers, excluded from coverage altogether, or losing everything we’ve worked hard to save and own, like our houses.

    Think about that next time you hear the theme. The press wants you to scrap any possibility of equalizing access to health care, because a pollster (and a conservative one at that) is telling us that we really hate ourselves enough to leave the status quo.

    That’s logic worthy of Sarah Palin and Glenn Beck. Oh wait! They’re probably the lead singers.

    And yes, there is a nod to tort reform, which is such a comprehensive topic it should not be contained in a bill about health care reform. Still, it acknowledges that it’s been suggested as a possible cost-saver in the larger scheme of things.

    The Lieberman Riff: It’s all about me

    Joe Lieberman. In his quest to get whatever it is Joe wants that he doesn’t have right now, he is standing tall for…Joe. I’m guessing a few more vigils like this one won’t make a huge difference, but ultimately Joe will get what Joe thinks he wants, until Joe gets tossed out of office by constituents who overwhelmingly disagree with him.

    Unsung Chorus #1: Conference Committees matter

    Back in September, the President held a conference call with progressives where they composed a strategy. The song went like this:

  1. Get the bills out of the committees. Check.
  2. Get the bills onto the floor of the House and Senate. Check.
  3. Pass the House bill. Check.
  4. Pass the Senate bill, even if it means adding triggers to the public option. Half a check for opening debate. Let’s see if Snowe introduces an amendment calling for triggers. If she does, it gets a full check.
  5. Pass the Senate bill with 60, where one of the 60 is Snowe or Collins. Bill has triggers for public option.
  6. House/Senate bills go to conference committee for merge. In Joint Committee, trigger is stripped from public option by House progressives on the committee. Conference report goes back to House and Senate, needs 51 to pass the Senate and we’re done.

Unsung Chorus #2: The whole is greater than the sum of its parts

While progressives’ intone the chorus that without a public option, health care reform is no reform at all, the truth may be something different. What the public option clearly does (and why it’s being fought tooth and nail by moderates and conservatives) is open the door to a single payer system somewhere down the line. Otherwise, it’s another choice bundled with other choices, only a public choice as opposed to a private one. I’ve seen arguments that suggest it will be the only choice that will offer a patient-centered approach, but I really think that’s idealism. Under one administration it may be something different than it would be under another. We’ve seen that with Medicare, and there’s nothing that convinces me it wouldn’t be true with a public option.

That doesn’t mean I’m against it. It just means I want everyone to step back and look at the larger picture.

The more delicate and complex melody lurks underneath the sound and fury; namely this: the entire package makes such fundamental changes to the system that it is indeed major reform that will bring the cost of health care down, with or without a public option, with or without triggers for a public option, with or without opt-outs for a public option.

No, I did not blaspheme.

Consider the analysis done by Tim Jost over at the Health Affairs blog. His evaluation is striking in its clarity:

This year’s health reform legislation has often been criticized for being health insurance reform rather than health care reform, and for not doing enough to control the cost of health care. Those who offer these criticisms have obviously not read the bills or even tried to understand them.

Jost goes on to outline how, between the two bills, just about every viable suggestion by credible sources and/or studies has been incorporated into the bill. Outcomes-based payment systems, payment bundling, quality reporting, electronic health records, patient-centered outcomes research, etc, etc. The list goes on.

These are not provisions contained in the consumer protection section of a nine-section bill. They are part of the other facets, which when put together create a new and wonderous thing. Here are the nine facets of health care reform addressed in the Senate bill.

  • Title I – Quality, Affordable Health Care for All Americans
  • Title II – Role of Public Programs
  • Title III – Improving the Quality and Efficiency of Health Care
  • Title IV – Prevention of Chronic Disease and Improving Public Health
  • Title V – Health Care Workforce
  • Title VI – Transparency and Program Integrity
  • Title VII – Improving Access to Innovative Medical Therapies
  • Title VIII – CLASS Act
  • Title IX – Revenue Provisions

There are some comprehensive and major paradigm shifts in this bill. That list of nine facets adds up to something greater than the presence or absence of a public option. This is what is being lost in the public debate over, and over, and over again. The finer cuts in each of those facets are the best ideas — regardless of the party who introduced them — for reforming the entire system.

It’s easy to fixate on one cut of one facet and think you’ve heard the whole mix, but it’s a little like pointing to “Yellow Submarine” as the seminal Beatles work of their career while ignoring masterpieces like the White Album. President Obama is a man of long strategies, not short-term end runs.

Let’s sing this song, loudly. If we don’t, it won’t matter what passes. It will all play out as some sort of loss for President Obama and the Democrats when in fact, it will be a huge win for each and every person who lives in these United States.

(cross-posted from odd time signatures)

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