Good news and bad news last night, as the House passed health care reform.
The good news is: the House passed health care reform. The work isn’t completely done yet, of course. The House had already passed a heath care bill, months ago, but this isn’t it; last night they passed the Senate’s version of the Bill, which had some glaring flaws. Under ordinary circumstances the House and Senate would get together and hammer out a compromise between their two bills. But in the meantime Republicans picked up an extra Senate seat in Massachusetts after Teddy Kennedy died, and they had promised to filibuster the compromise package. (Because, after all, what courageous moral stand could be worth invoking arcane parliamentary procedures more than the fight to prevent millions of people from getting health insurance, especially if that was the life’s goal of the Senator whose death allowed you to improve from having twenty fewer votes than the opposition to only having eighteen fewer votes?)
So Obama will sign the Senate bill that the House just approved, and then the Senate will consider a reconciliation bill also passed by the House last night. Under even-more-arcane procedures, the reconciliation measure can be passed without threat of filibuster. It requires only “majority vote,” a quaint notion in this highly baroque age.
It’s not an especially huge bill, whatever you may have heard, but it will have an impact. Here is a list of the major impacts, and an interactive graphic to figure out how you will be affected. The most important features seem to be:
- Establish health insurance exchanges, and provide subsidies for people below four times the poverty line.
- Guarantee insurance for people with pre-existing conditions, and eliminate “rescissions” that take away insurance from people who get sick.
- Push business to provide insurance for their employees, and self-employed individuals to buy insurance for themselves.
- Close the “donut hole” in the existing Medicare payout structure.
- Implement cost controls (mostly through slowing the growth of Medicare spending), thereby lowering the budget deficit by $130 billion over the first ten years, and by another $1 trillion over the next ten years.
Overall, it’s a relatively incremental bill, placing bandages over some of the more egregious wounds in the current system, while leaving in place the essential structure through which we funnel billions of dollars to middlemen while paying far more for medical care per person than any other country without getting better results. For 90% of Americans, coverage and insurance will continue as before. Basically, this brings us a little closer to where Western Europe was a century ago.
Still, a tremendous political accomplishment — maybe not from the perspective of what we were hoping for when Democrats took control of both houses of Congress and the Presidency in 2008, but certainly from the perspective of the last couple of months, when it often seemed like we weren’t going to get anything at all. More than anyone, credit for the accomplishment goes to Nancy Pelosi, who didn’t give up when things looked grim. From now on she won’t simply be known as the first female Speaker of the House, but one of the most effective leaders in its history. Here she is marching to the Capitol yesterday, arms linked with civil-rights pioneer Representative John Lewis from Georgia, carrying the gavel that was used when Medicare was passed in 1965. An historic moment.
Which brings us to the bad news. One of the reasons why Pelosi was marching with Lewis was to demonstrate support a day after this man who had marched at Selma was repeatedly called “nigger” by protesters outside the Capitol. Ugly by itself, but worse in context: it’s becoming harder and harder to have a meaningful debate in this country without participating in a race to the rhetorical bottom.
There exist reasonable arguments against health-care reform; not arguments I agree with, but ones that at least make superficial sense. It costs money to provide insurance for the uninsured, and someone will have to pay. Asking healthy people to buy insurance will be a burden to them. There will be less extra money floating around if we cut down on unnecessary costs, which might impede the pace of medical innovation. (I didn’t say they were great arguments, just that they made superficial sense.) But these aren’t the arguments that are actually made most frequently. Instead we hear that the Democrats are abandoning the principles of representative democracy by passing legislation while they control both legislative houses and the executive; or that liberals won’t stop until they have swept away the last vestiges of personal choice in American life; or that the government wants to decide when to kill granny. Right-wing bloggers nod with approval at the idea that people are stocking up on guns, preparing for fighting in the streets. The race to find the most scary and overheated characterization of a pretty benign state of affairs is a fierce one.
The most depressing aspect of the situation is not the existence of crazy fringe elements — those will always be with us, on both sides of any issue — but of the reinforcing dynamic between the fringe and the supposedly respectable parts of the Republican party. It’s been clear for a while to most people (outside the White House, anyway) that Republicans in Congress made a clear choice that their own self-interests are served by preventing Democrats from passing any meaningful legislation, whatever that might mean for the good of the country. Speeches during House “debate” last night consistently played to the worst aspects of the protesting mob. One Congressman shouted “baby killer!” at Democrat Bart Stupak, who is staunchly anti-abortion, as he spoke to support the bill. [Update: it was Randy Neugebauer (R-Tex.).] Two protesters inside the House chamber were arrested for being disruptive — and “several Republican lawmakers stood up and cheered during the interruption.”
Lest you think this is simply concern-trolling from a liberal telling conservatives to be less intrusive, note that conservative commentators like David Frum are making the same point: the rhetoric has gotten out of hand, and it’s not good for anybody, except maybe the “conservative entertainment industry.”
I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government. Talk radio thrives on confrontation and recrimination. When Rush Limbaugh said that he wanted President Obama to fail, he was intelligently explaining his own interests. What he omitted to say – but what is equally true – is that he also wants Republicans to fail. If Republicans succeed – if they govern successfully in office and negotiate attractive compromises out of office – Rush’s listeners get less angry. And if they are less angry, they listen to the radio less, and hear fewer ads for Sleepnumber beds.
I’m not sure what the end game is — whether it’s possible to step back to a more reasonable dialogue. Disagreement is good, and it’s important to have an active and engaged opposition party, no matter who the majority party might be. But whipping up hysteria at the cost of working together constructively isn’t in anyone’s interests. Obama campaigned on a message of hope and change and bipartisan togetherness, and I think that was a sincere message on his part; but it certainly hasn’t come to pass, and there doesn’t seem to be any indication that it will.
@tacitus
http://www.marginalrevolution.com/marginalrevolution/2009/11/what-should-we-do-instead-of-the-health-reform-bill.html
My 3 favorite parts of Tyler Cowen’s proposal:
6. Make an all-out attempt, comparable to the moon landing effort if need be, to introduce price transparency for medical services. This can be done.
7. Preserve current HSAs. The Obama plan will tank them, yet HSAs, while sometimes overrated, do boost spending discipline. They also keep open some path of getting to the Singapore system in the future.
9. Establish the principle that future extensions of coverage, as done through government, will be for catastrophic care only.
Push for cost transparency in non-emergency care. HSAs give people some incentive to shop for better price and quality. Government mandates only require catastrophic policies (limiting the cost we all bear for uninsured ER visits).
Thanks Sean, as others have said, for a well-researched precis. With passion. As a native American, whose ancestors here can no longer be traced (we go back very far in Massachusetts), it is profoundly embarrassing to me that we still have not overcome the divisive elements who wish to separate us solely to keep us from attaining the basic social contract which existed in Western Europe 50-80 years ago. Since I am half Swedish, this makes me even more embarrassed. No excuses allowed.
“I claim it is wrong to take by force the fruits of one person’s labor and redistribute them to someone else, no matter how noble the ends. I guess that makes me an uncivilized idiot.”
Yes, it does make you an uncivilized idiot. It’s called a circle of empathy. Liberals tend to make the circle very wide, even including animals, and in my case, sea lampreys. Conservatives tend to make the circle very small, sometimes excluding their own mother or sister. Only you can decide where you draw the circle. But in a civilized society, we are actually required to care about someone other than ourselves. This is the social contract. This is the Parable of the Good Samaritan. Or, as Chris Rock says, you don’t get credit for doing things you’re supposed to do.
the only thing that concerns me is whether I am four times below the poverty line or not
Carl Brannen, the health benefits of exercise are by now very well established. Given the obvious error in your first statement I find it hard to give your remaining statements any credence.
What I object to in all of this wrangling is that nothing substantive was done to correct the underlying flaws in our healthcare model – Congress slapped on band-aids, covered a bunch more people without doing anything that guarantees that additional cost won’t be financed by middle class taxpayers, and did so in an entirely partisan, force majeure sort of way that should be nauseating to spectators of any party affiliation.
Oh, and Mr. Watts – only an idiot would actually criticize another’s argument in such cavalier fashion. The point of a free society is to be ABLE to help others as you see fit and encourage others to do the same, not to be COMPELLED to do so by one’s government. Your “circle” may extend to sea lampreys, but you have no right, and neither does our government to tell me what my circle is, and I bitterly resent the excessive amount of money taken from me and my family that ends up funding the lifestyles of social parasites. We have let welfare and entitlement programs run so amok in this country that we make living perpetually on the public dole a possibility, perhaps even a lifestyle choice, and that level of parasitism is ultimately insupportable. And before you assume I’m a right wing nut job, let me also state that I am a Harvard educated science teacher in a Title I high school – I see the dark side of welfare every day. I have no problem helping those in genuine need, but we have allowed that assistance to become a crutch for far too many people who might otherwise be productive members of society.
gee – don’t quit your day job. This nonsense is why i come here less and less often.
@ GuryOfChem
I understand your issue with some entitelement programs. And that issue does not make you a right wing nut.
Even though health care coverage is considered by most to be an entitlement program, it has a slightly different look and feel for me. Most people who don’t see doctors simply never had the money to save for that rainy day, are not able to afford the monthy costs of insurance, or are denied insurance for pre-existing conditions. This does not feel like help for “parasites”. It is an opportunity for someone to become productive. Or to have legitimate options to see their sick child see a doctor and receive appropriate medical care. I don’t think this HAS a dark side. No matter how many abuses you have seen for other entitlement programs.
On other non reply related commentary:
The problems with Heath Care are many. This bill only BEGINS to address but one or two of them. Is this the end of the road? No. We have more reform to go, especially on the insurance/expense end of things.
Republicans were given EVERY opportunity to be a part the solution, and refused each and every time to genuinely engage in the process. Now they are angry this is being “pushed” through. Sounds like a child who doesn’t want his toy, but won’t let anyone else play with it either. the arguments that we are rushing to pass this is a sad ploy to stall initiative and just derail the process.
The only thing I can give them points for is consistency and solidarity. Even if they would prefer to see our country sink and fail than to concede on some partisan positions.
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I for one was glued to my television for the numerous healthcare discussions between Republicans and Democrats in both the House and Senate, fulfilling the promise that President Obama made to be more transparent. It justified my vote for the man. I also reacted with glee when being told that I will be fined, if I refuse to obtain healthcare insurance. I am waiting for my mandate to purchase a government motors automobile, as my present vehicle is 7 years old.
I guess I’m cynical because I thought my party would do a better job than the previous party in power has already done, or failed to do. This is more of the same, tired, political invectives thrown across both sides of “the Aisle”. What happened to insurance portability? Where is tort reform? I hope this healthcare bill helps those who really need it. I doubt it will do anymore than previous attempts to socialize business models that operate at or below the efficiency of private businesses. I think I’m going to register as an independent, because I no longer believe in the promises of either party.
To attribute differences in lifespan to health care alone is silly. Russia has “free” health care and a 10-year shorter lifespan than the US and Europe. Lifespan is largely a function of your drinking, smoking, drug use, eating, unsafe sex habits, dangerous driving, inclination towards violence, religion, crime, lack of education, genetics, etc., health care is a minor input. The US is not comparable to Northern Europe in these things.
And I don’t doubt that getting no exercise is bad for your health, however, the people I know who exercise to excess are constantly interacting with the medical profession to repair damage they’ve done to themselves. If you doubt this pick up a copy of “Sports Illustrated”. It’s not stuff that kills you; torn ligaments, etc., but it does put you in a doctor’s care. And it’s obvious to me that hurting yourself exercising is rough on your enjoyment of life.
To imagine that the government will save money when it takes over an industry is naive in the extreme. The US government has never done anything efficiently in the past. Any money saved from reduced profits will be more than lost in waste and fraud. And it appears that this is going to be done with unfunded mandates to the States. Right now the States are broke; unlike the Feds they cannot print money. The result is likely to be even more severe squeezes on State spending. Hmm. One of the most convenient places to reduce State spending is in higher education.
The whole situation reminds me of 1976 and Jimmy Carter.
Hi Braemar,
Thank you for responding to my posts.
Where is the tipping point, the point where you will not give up any more of yours to help another because you will not be able save yourself?
You describe a dilemma which, quite frankly, I have never encountered personally. You seem to think of giving as a sacrifice and ask, “How much are you willing to sacrifice?” To a pretty good first approximation, I have never sacrificed anything for anyone – I give what I desire to give.
Sean-
As much as I enjoyed your lectures for the
Teaching Company and the insights this blog provides into a world I don’t know much about, your statement “Asking healthy people to buy insurance will be a burden to them” does not inspire confidence in your analysis. Perhaps you would prefer a world where you could wait until your house was burning to buy fire insurance and expect someone to insure you at some rate for “average” risks you since you were suddenly willing to pay an insurance premium for the certain claim? It requires neither expertise in quantum physics or rocket science to do the math and calculate the economic cost you should pay for insurance or the adverse impact your sudden coverage at “average” rates will have on everyone else “in the pool”.
Calculating age adjusted rates for insurance is fairly easy, setting socially/politically acceptable rates hard and letting people wait until they are sick to buy insurance, economically impossible unless as a society we want to pay all medical costs from general tax revenues.
As one who spent over 50 years in the insurance industry including 20 years as an independent consultant/ banker/entrepreneur, I find it hard not to believe that a rapid transition to Medicare for all would be the optimum economic and social solution for our nation but one that given our history is neither feasible or practical. I consider the present legislation a major political accomplishment that provides the basis for actually coming to grips with a social/economic problem comparable in many ways to the “banking” problem that has cost and is costing our nation and many hard working , decent people dearly. Let’s hope we can take a major step in that direction as well, finding a path between the avaricious rent seekers and the puritanical utopians that might actually work.
I got timed-out on my last post. I continue.
I heard this tonight and I feel it is probably close to the center of this matter:
Democrats see this as a moral issue and Republicans as an economic one.
Every Democrat is different from every other Democrat, and every Republican is different from every other Republican. Their points of view are numerous and varied.
Anyway, I thank Braemar and so many others, with a special tip of the cap to Sean. I am enjoying your thoughtful comments. I am delighted that we can all discuss this without sniping at each other.
I bitterly resent the excessive amount of money taken from me and my family that ends up funding the lifestyles of social parasites.
I accept the “bitter” part. The rest is the self-pitying whining of a kid told by his mother to share his toys with his sister.
You better get this straight. Congress is NOT granted the power to tell Americans what to do – but this HC bill tells you to buy insurance.
A majority vote to tell you what to do is called TYRANNY OF THE MAJORITY.
Get it ? IF they can tell you to buy insurance
then they can tell you to buy Solar Panels or anything else some majority wants. The constitution does NOT delegate any such power.
Thus – Conyers must be CENSURED and IMPEACHED.
He and his pals are setting up a tyranny of the majority.
jr,
Do you currently have medical insurance?
Andy Borowitz suggests a teabagger sign which says Keep the Government out of Congress
The government pays about 60% of health care costs now- and it has risen under the Republicans.
I personally pay for my health insurance(about $750/month) and a few hundred a month toward hubby’s medicare supplements and daughter’s college insurance, relatively cheap. I planned on that when I retired.
I believe that Brian137, you have not yet understood the question. And I suppose since you are not in the situation yet, you are not planning ahead. So I will rephrase.
Q: If you knew that you had a limited amount of resources to use to protect your own family/partners, someone you care greatly about, would you keep tighter control of those resources?
Another rephrase of the same question: Will you feel well-being threatened if you need to protect yourself and lose control of your assets?
I am one who likes to pay for my family and myself and do not want to trust the govt to take care of me. So I do not want to give up my resources to pay for others when I need to make sure my family is getting the lifesavig care or meds when needed.
It seems that there is a growing idea that the govt has some stash of funds to use for all of us. The reality is lost about where that comes from. The free lunch is not free, just paid for by others.
We are gathering a larger and larger group who have found out they can survive pretty well without much effort. Like pavlov’s dogs, we are training certain parts of the population to make do with govt welfare.
Am I uncompassionate? No. Do I give to many charities and have people stay in my home at times of their need? Yes.
I do not believe that large facets of society should feel that the govt owes them care or that others who were more successful through hard work should be expected to fund their needs. Not a smart idea. The nation will collapse under the weight of the pull of those being paid to wait for more handouts. This stifles entrepreneurship and small business start ups that are the engine for jobs to those paying taxes.
Yes, the truly needy should be helped. The generations shoudl bnt be perpetuated in a living off the govt lifestyle. And yes it is happening.
Hi Braemar,
Thank you for describing your feelings and your situation more fully. I respect and admire your genuine concern for yourself, your loved ones, and others in general. You seem like one of the people I hope health care reform can help. I believe the intent of the bill is to make things easier, not more difficult, for people in your situation. You raise the specter of unintended consequences doing more harm than good. That problem is certainly all too frequent. I wish you the best, and I am rooting for you.
My larger concern is that we (in the person of the federal govt) are moving in the direction of having more people voting for benefits than are paying for them. When we reach the tipping point, and we are close, the nation will collapse.
How much of your weekly wage will you give to pay benefits you can not get while you work to pay for benefits to others! full circle
Braemar,
I do not foresee a “collapse” of the American economy so much as a gradual (but perhaps steep) decline. Some of the reasons for this trend are beyond our control. Chance factors initially favored us, but the field is becoming more level. Many of the causes of this putative decline will be of our own collective creation, engendered by greed, callousness, and lack of foresight. I do not regard love, generosity and good will toward each other as our major problems.
CEO salaries are a perfect example of economic parasites. People on welfare or the dole may not contribute much to the economy, but nearly 100% of that money is pumped back into the economy as these people have very little savings. If CEOs are earning 400 times the average worker’s salary instead of 50 times, that’s 350 less full-time jobs in the economy. Sure, the CEO may spend his/her exorbitant salary and create jobs elsewhere, but it won’t be anywhere close to 350 due to wealth/income sheltering, i.e. the failure of trickle-down economics.
If the income tax rate in this country were increased back to post-ww2 levels of 90% on the highest bracket, not only could the US finance a truly high quality single payer universal healthcare system, it could do so without suppressing GDP one bit, since, in terms of total GDP % on healthcare, the US already outspends every other nation on the planet.
61. Carl:
You might want to actually READ that link you provided,,,
“Although there are more than 300 private insurers and numerous public ones in the market, real competition for patients is rare leaving most patients with little or no effective choice of insurer, and in many places, no choice of health care provider either. The insurance companies have failed to develop as active, informed purchasers of health care services. Most are passive intermediaries, making money by simply channelling funds from regional OMS funds to healthcare providers.”
Their(Russian) health care has gone into the bucket. So, shorter life spans. They don’t have health care providers to anticipate health problems(preventive care).
You used a very bad example.
GAry 7
Sean, I agree with your post, although for purposes of framing the issue, I wouldn’t call it “Obamacare”. That’s a derogatory term used by right-wing loonies who deny reality. It’s best not to use their language so as not to let them define the debate.