Passed

As a sometimes political blogger, I guess I'm contractually obligated to post about the passage of health care reform. It passed 219-212 last night.

First, there's a sense of relief at finally passing something. HCR has been up and down like a kangaroo in the mating season over the past year, and the machinations in the process have been amazingly frustrating. The disingenuous and dishonest advertising against the bill was truly appalling. Or maybe it really does mandate gay abortions of Grandma.

The bill itself is a piece of astounding mediocrity. It barely meets any definition of "reform", and is far too weak to actually meet the needs of the American people. But (in my opinion) it's is on balance better than doing nothing. I do have a personal bias here; as a walking, talking, living, breathing 'pre-existing condition', the provisions will help me in the future. Not a great amount of help, but at least it's something.

Sure, I'd prefer "single payer", or at least the "public option", but the reality of our current political climate made that impossible. There just aren't enough progressive votes to overcome republican obstructionism.

In a way, the simple fact that the bill was passed is an important success. The GOP threw everything they had at defeating it, and they lost. Moving forward on financial reform, jobs, energy, etc. will now be possible as a result of winning this battle.

On a side note, I don't think I'd want to get into a poker match with Nancy Pelosi. I might quibble with her style, but when it came time to whip the votes she played her hand quite deftly.

Health Care Summit Theater

Will it accomplish anything? That's the real question. Can Obama make the debate move forward, or will it be theater and political grandstanding?

I will be watching, if for no other reason than that the summit is such an unusual political move. Given that health care reform has been up and down like a Kangaroo in the mating season, I have no prediction as to the outcome. I will be interested to see which rhetorical points each side chooses to focus on. Sadly, the whole process of health care reform has gotten stuck on "framing" rather than actually addressing the very real need to change our system.

We're a very strange country; we have no problem funding wars, but when it comes to taking care of our own people we talk about our deficit. It's a sick system.

Can Anybody Here Play This Game?

To paraphrase 'Ronald Dumsfeld', you go to legislate with the Democrats you have, not the Democrats you wish you had. But I'm starting to wonder if the current Democrats are even trying. The senate health care bill, bad as it may be, is the only option left in the playbook. The house's choice is to either pass it, or forget about health care reform for another generation.

I understand the lack of enthusiasm for the bill. It really isn't anywhere near the strong reform we deserve, but there is enough benefit to regulating insurance to make it worthwhile. (I admit that I have a bias; as a walking "pre-existing condition" I have a vested interest in it passing.)

So yesterday, I called my congresswoman's office to express my view. Now, regular readers know that my congresswoman is a proud standing member of the "soggy-waffle caucus" who can avoid taking a stand on almost any issue that might be remotely controversial, so I wasn't expecting much. But I was rather surprised at the staffer's lack of information regarding the status of the bill, or negotiations on it. I had kinda hoped that a political employee might...you know...pay some attention to politics. I'm so naive sometimes.

Let me spell this out simply for the Democrats: you need to pass this if you wish to maintain any political viability for the remainder of this term. If the republicans win on this, they will block every other attempt at legislation by the same means. I hate to see governing reduced to a 'game', but that is the current reality. Score now, or forfeit the game.

Added: New Democratic party slogan:

"That Lemming seems to know where he's going! Let's follow."

The Least Bad Option

Not that my opinion really matters, but like most every progressive I'm disappointed in the health care bill. It's weak on health, short on care, and far from reform. But, sadly, it's the best we're going to get at this time. A lot of democrats/liberals are bitter that the senate failed to do better, but the alternative was to do nothing. And that would be worse. If the current bill failed, it would be at least twenty years before health care would be tackled again. At least the current bill can be built upon during the coming years. If nothing else, it beats letting the rethug obstructionists win.
Sigh...we really do deserve better.

Understanding Priorities

Health care will be expensive. 78 billion, 80 billion, 91 billion per year are the numbers under debate. Perhaps 1 trillion over 10 years. Sounds like a hell of a lot of money.
The grand adventures in Iraq and Afghanistan have run between 108 and 140 billion per year over the past 8 years, with a total cost around 1.3 trillion so far (actual number is probably higher).
The annual defense appropriations bill passed a few weeks ago came in at 680 billion (they did have to work late on this, so it includes the cost for congressional pizza delivery), for 1 year.
Our priorities are clear. We'd rather spend our money on damaging bodies than on healing them. Bombs: they're more entertaining than colonoscopy's.

Health Care Hash

The House passed the healthcare bill last night, 220 to 215. By the time all the amendments were done, it became a very mixed bag. The Stupak amendment restricting abortion funding is particularly odious; a real offense against poor women.
But there are some good points to the bill as well:
* coverage of as many as 36 million uninsured Americans
* ends subsidies of private insurers under medicare advantage
* closes the "donut hole" in medicare drug coverage
* allows medicare to negotiate drug prices
* prohibits denials based on prior conditions, and ends rescission's except in cases of fraud
* funds more education of doctors and nurses
* includes the seeds of a real public option
Do we deserve better? Yes. Is this as good as we can get at this time? Probably.
Speaker Pelosi said she had the votes, and in the end she did. My own congress waffle, Ann Kirkpatrick, ended up voting "yes" after much dithering, as I thought she would (and she actually had enough spine to vote against Stupak, which mildly surprised me).
With our current dysfunctional congressional system, this compromise is probably all we can get. But it really is a shame that women's rights were sacrificed to get it.
Now it's on to the Senate, where the circus will be even more ridiculous. Lord only knows what we'll be looking at by the end of that process.

Another Rethug Idiot on Health Care

OK, it's not news, but Rep. Broun sinks to a new low:

One of the most radical opponents of health care reform is Rep. Paul Broun (R-GA). He has said that a public option would “kill people.” Last Tuesday, Broun was confronted by a constituent at a health care town hall who explained that he has has gone into debt because he can’t afford insurance for his major depressive disorder. In response to his constituent’s story, Broun said that “people who have depression, who have chronic diseases in this country…can always get care in this country by going to the emergency room.” That comment prompted boos from the crowd. Towards the end of Broun’s answer, a constituent yelled, “That’s why we need a public option!” which brought cheers from the audience. (video at link)

http://thinkprogress.org/2009/10/01/broun-emergency-room/

As a former mental health counselor who's suffered bouts of depression myself, I'm outraged at this. Chronic depression (like all chronic diseases) requires long term treatment. Ideally, a combination of counseling and medications are used, but currently it's mostly just medications. They're cheaper. Emergency treatment of depression usually comes as a result of a suicide attempt or serious suicidal ideation. So the congressman was basically saying "go attempt suicide, and you can get treatment". If you survive.
Perhaps the most stunning part of the whole health care debate is how blatant the rethugs have been about there lack of compassion for their fellow human beings. It's one thing to be a cold heartless bastard, another thing to proudly publicly proclaim it.

Dissecting the Baucus Bill

Feel free to dissect it all you like. Because it's dead. Carve it up into tiny pieces. It's going no where.
Six months trying to assemble a bipartisan zombie have only created a cadaver.
The rethugs won't support it. Progressive dems won't support it. The public won't support it.
I'm not sure what sort of reform will eventually come out of the congressional sausage making process, but I'm quite certain that this isn't it.

Retro Debates

Everything old is new again; nostalgia isn't a new phenomenon. And the health care debate is another echo from the past:

Sept. 14 (Bloomberg) -- The debate is about health care. The threat is of a march toward “socialism.” The words come from a famous voice. Not Sarah Palin in 2009. It was Ronald Reagan in 1961.

“From here, it’s a short step to all the rest of socialism,” Reagan, then an actor, warned in a 1961 record sponsored by the American Medical Association after President John F. Kennedy created a commission that laid the foundation for Medicare.

Many of the arguments against President Barack Obama’s overhaul effort are refrains from previous debates over health- care policy and Social Security dating to Presidents Theodore Roosevelt, Franklin Delano Roosevelt and Harry Truman.

“There are substantial echoes of the past rhetoric in what we’re hearing today,” said presidential historian Robert Dallek.

In 1945, the AMA helped portray Truman’s proposal for national health insurance as a creep toward communism. Three years later, the U.S. Chamber of Commerce produced a pamphlet, “You and Socialized Medicine.” In 1993, the health-insurance industry tried to scuttle President Bill Clinton’s proposed overhaul by funding ads featuring a fictional couple who decried a “government takeover” of health care.

http://www.bloomberg.com/apps/news?pid=20601103&sid=ayd_OJxPgHII

Time to try some new arguments, people.

Speech Reactions, and the Really Bad Analogy

Overall, I thought Obama's speech was pretty good, but not a "game changer". Because I watched it in the company of about 50 local democrats (who were very enthusiastic), plus the usual mix of bar patrons (who were more subdued), the audience reaction I saw skewed to the positive. I'm not sure the overall population reaction will be as upbeat.


While we already knew that Obama is a very strong orator (especially compared to the last guy), he again showed his ability to speak to the public as adults. He didn't shy away from articulating complex issues. That's good.


He did push for the "public option", but no where near as forcefully as I had hoped for. I'm not surprised, but I am disappointed. He's still trying to sound "bi-partisan", but that train left the station a long time ago. I think he was trying to be polite to the repubs.


Which wasn't reciprocated. The outburst by Rep. Wilson (R-S.C.) has garnered a lot of media attention, but the reaction is mostly negative. Wilson is now a prime example of republican obstructionism, and rude to boot. (BTW; his outburst was clearly a violation of House rules on decorum. This isn't the House of Commons.)Added: specific rule: " Refrain from speaking disrespectfully of the Speaker, other Members, the President or Vice President."http://rules.house.gov/archives/house_decorum.htm


But the part that bothered me the most was the really bad analogy: comparing health insurance to car insurance. Simple fact: not everybody has to have a car, but everybody does have to have a body. I've been "car free" for over twelve years, and I have no plans to get a car in the foreseeable future. But I do have a (albeit aging) body, and it requires health care. I choose not to have a car. I didn't 'choose' to break my shoulder, and treatment was not an "option" (unless I wanted to be permanently disabled). Comparing health insurance to car insurance is like comparing apples to lobsters.

Overall, I think Obama's speech moved health care forward, but only by a small step. I'm convinced will get some kind of reform, but at the end of the sausage making process, I'm not sure how significant it will be.

Avoiding Whiplash

If you're following the whole "healthcare reform" process, you're at serious risk for whiplash (which is why I've kept my distance). Both the political debate and the public debate have sunk into street theater, instead of movement toward a goal.
On the political side, the "public option" is back and forth like a tennis ball at Wimbledon. It's in, it's out, it's back in, or maybe it's out. It's going to be "bi-partisan", but one party will oppose anything at all. So the Dems will go it alone. Except if they don't. Even if you're paying close attention to the process, the picture is about as clear as mud.
The public debate is even more absurd. People with guns screaming about "death panels" get TV airtime as if they were credible. People on Medicare decrying "government run healthcare", proving we really need a better mental health system, seemingly have zero sense of irony. Never mind the "facts" (which are rather dull), let's focus on the absurd. The lobbyists are having a field day. It would be really entertaining if it weren't so tragic.
Somewhere in reality there is the main actual proposal, H.R. 3200. While it's certainly going to go through changes in the reconciliation process, this is what is actually currently "on the table". Good friend badtux the snarky penguin has put together the best summary analysis that I've read so far:

Well, basically, HR3200 is a strange amalgation of the German system -- which has publically owned nonprofit sickness funds and for-profit insurers largely funded by employer contributions with all citizens required to purchase insurance if not provided by employer (and all employers required to provide insurance for their employees) -- and the Swiss system, where individuals purchase insurance in a heavily regulated must-issue must-have individual insurance market (that is, insurers are required to issue insurance that meets minimum standards w/no pre-existing conditions exclusions, and individuals are required to purchase insurance). Subsidies are provided in both systems so that people who cannot afford to buy insurance on their own can afford to buy insurance, and HR3200 includes similar subsidies. One thing HR3200 does *not* do is force employers to provide insurers -- if employers refuse to provide insurance, instead HR3200 taxes them 8% of payroll
in order to fund subsidies so the employees themselves can afford to buy individual insurance.

There's no reason why HR3200 should not work as designed -- the public option in the German system keeps costs low, the 8% tax encourages employers to provide employer-provided insurance, while the various mandates and subsidies insure that all Americans can afford and obtain insurance that will cover all common health costs -- but of course it is nowhere near the most efficient way to provide health care. The system HR3200 sets up will provide universal healthcare, but at a cost much higher than a single-payer system. Still, it's a whole lot better than the current system, which is "let them eat cake" filled with rescissions, refusals to insure due to pre-existing conditions, discrimination against women, older Americans, and against families with young children, and far too many people who cannot afford to purchase health insurance and cannot obtain any subsidy for doing so.

"What HR3200 really is"

So, it's not "bad", but it's also not all that good. It may be the best bill we can get passed in the current climate, but it's not a solution to the healthcare crisis.
Like most "liberals" ("socialists" in the current lexicon), I would really like a "single-payer" system. It's not even "on the table", but Thom Hartmann has a really simple, good proposal:

Dear President Obama,

I understand you're thinking of dumping your "public option" because of all the demagoguery by Sarah Palin and Dick Armey and Newt Gingrich and their crowd on right-wing radio and Fox. Fine. Good idea, in fact.

Instead, let's make it simple. Please let us buy into Medicare.

It would be so easy. You don't have to reinvent the wheel with this so-called "public option" that's a whole new program from the ground up. Medicare already exists. It works. Some people will like it, others won't - just like the Post Office versus FedEx analogy you're so comfortable with.

Just pass a simple bill - it could probably be just a few lines, like when Medicare was expanded to include disabled people - that says that any American citizen can buy into the program at a rate to be set by the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) which reflects the actual cost for us to buy into it.

So it's revenue neutral!

To make it available to people of low income, raise the rates slightly for all currently non-eligible people (like me - under 65) to cover the cost of below-200%-of-poverty people. Revenue neutral again.

Most of us will do damn near anything to get out from under the thumbs of the multi-millionaire CEOs who are running our current insurance programs. Sign me up!

This lets you blow up all the rumors about death panels and grandma and everything else: everybody knows what Medicare is. Those who scorn it can go with Blue Cross. Those who like it can buy into it. Simplicity itself.

Of course, we'd like a few fixes, like letting Medicare negotiate drug prices and filling some of the holes Republicans and AARP and the big insurance lobbyists have drilled into Medicare so people have to buy "supplemental" insurance, but that can wait for the second round. Let's get this done first.

Simple stuff. Medicare for anybody who wants it. Private health insurance for those who don't. Easy message. Even Max Baucus and Chuck Grassley can understand it. Sarah Palin can buy into it, or ignore it. No death panels, no granny plugs, nothing. Just a few sentences.

Replace the "you must be disabled or 65" with "here's what it'll cost if you want to buy in, and here's the sliding scale of subsidies we'll give you if you're poor, paid for by everybody else who's buying in." (You could roll back the Reagan tax cuts and make it all free, but that's another rant.)

We elected you because we expected you to have the courage of your convictions. Here's how. Not the "single payer Medicare for all" that many of us would prefer, but a simple, "Medicare for anybody who wants to buy in."

Respectfully,

Thom Hartmann

http://www.commondreams.org/view/2009/08/17

Of course, this has a snowball's chance in Turlock of ever passing. Good ideas aren't allowed in the current dialogue. There is no army of lobbyists for "common sense".

My own personal healthcare is paid for by the state of Arizona. Because I was unemployed when I broke my shoulder, I'm enrolled in "AHCCCS", the "Arizona Health Care Cost Containment System" (the name makes clear their motivation), and as long as I remain below the poverty level I'll continue to receive basic health services on the taxpayers dime. I can't complain; the service has been adequate and my Dr.'s have been top-notch. The problem for me is that if I ever rise above the poverty level, I'm screwed. I'm uninsurable thanks to pre-existing conditions, and unless I got really, really rich there's no way I could afford the treatment I need out of pocket. And a lot of Americans are in even worse shape.

So that's where we stand: A huge problem, a number of vested interests in the status quo, weak political leaders without real solutions, a largely ignorant populace inflamed with rhetoric, and a dysfunctional legislative system determined to avoid real action. And I only say this because I'm trying to remain optimistic. Because if you watch too closely, you're likely to suffer whiplash.