Health Care Reform - Form vs. Function

With the Christmas Eve passing of Health Care Reform by the Senate, it is likely that early in 2010, we will get and actual bill signed into law by President Obama. The real sausage-making now happens as a committee made up of members of the House and Senate reconciles the differences between the 2 bills. This final version cannot be amended, only voted up or down by each Chamber.

There will have to be some resolution to the differences on the Public Option (House has one, Senate doesn't at least not in name), funding for abortions (they have different restrictions), and financing (House taxes additional 5.4% on incomes over $1Million for families and $500K for individuals, Senate taxes high cost health insurance plans).

While it is possible that the committee reconciliation may not be acceptable to be approved in one of the Chambers, that rarely happens. Nobody wants to be known as the politician who voted for a bill and then was reason it was defeated once it came back from reconciliation. In the minds of many Americans, this bill has already passed. Some members of the House or Senate may change their vote on the final bill, but NOT if it would change the outcome of the vote. Some politicians may want to be able to tell their constituents they took a stand against something in the final bill, but nobody who has already supported Health Care reform wants to be the reason it fails.

I think the financing difference will wind up being a blend of the 2 methods.

I am a bit concerned about what the committee can put together on abortion restrictions that can be supported by Ben Nelson of the Senate (who was the reason it is in the Senate bill in the first place) that doesn't effectively create State by State decisions on Abortion Rights. The Senate bill allows states to block plans that cover abortions from being allowed in the exchanges.

I do want to spend a little time going over the so-called Public Option that caused such a stink during the Senate proceedings. Due mostly to Joe Lieberman from the state of insurance companies, there is nothing labeled as a 'Public Option' in the Senate bill. This has caused great disdain among many on the Left.

It may be tough to put something in the final bill that uses the tagline 'Public Option'. Although the final bill cannot be amended, it can still be filibustered in the Senate and they are only one person away from having that happen on the final vote.

However, the Senate bill is not without some 'options'. The Senate bill would actually have the Office of Personnel Management oversee at least two nationwide health plans from private firms offered through the exchanges to individuals, families, and small businesses. Additionally, at least one of those plans would have to operate as a nonprofit organization. This isn't trivial. This doesn't have the NAME of Public Option (FORM), but we certainly start with some alternatives (FUNCTION) to existing for-profit run and un-moderated health plans. This is also ripe for adjustments, additions, etc. in the future and may very well morph into something resembling the House version of a Public Option over several years.

After reading a lot of progressive blogs on the topic, it seems to me that the biggest reason for really wanting a Public Option is to stick it to the Insurance companies and eventually put them out of business. That seems to be something that liberals and conservatives can agree on although they feel very differently about the outcome. I'm not sure hatred is ever a good reason to include something in a law and this is no exception. Even the Senate bill includes some options that provide a limited amount of competition to the existing for-profit companies. It is not clear that a pure Public Option would have the effect of lowering costs.

However, in the final attempt to get Ben Nelson's vote, the Senate implemented a measure that may wind up being more effective in reducing health insurance costs. Health Insurance companies must now spend 85% of premiums on patient health care. This will put a significant cap on runaway profiteering and runaway premiums.

The Senate bill and likely the bill that comes out of committee will not have something called a Public Option (FORM), but there will be several measures that will work together to provide health insurance options in the exchanges and keep premiums down (FUNCTION).

That is how good politics are played. You get the results you want in a way that upsets the fewest people and their pet concerns.

Senate Health Care Bill to be an Early Christmas Present

Barring any last minute roadblocks, the senate will convene at 8AM on 12/24/2009 to vote on their version of the Health Care Reform bill. Then they will all head out of town for the holiday break.

It has been a long road (almost 100 years if you go back to the first attempts at Health Care reform legislation) and it isn't over yet. There would still need to be a committee reconciliation resolving the differences between the House and Senate bills, which then would need to be voted on by both parts of Congress.

There are complaints on both the Right (this will destroy health care) and the Left (nothing should be passed without a public option), which instinctively leads me to believe that maybe we got this bill right.

Although this bill is "watered-down" from what Progressives want and is a horror story to conservatives, there are a few basic things that this bill will do that have been needed for a very long time:

1) Up to 30 Million US citizens who are not currently insured will be able to obtain insurance through exchanges, in many cases with public subsidies making it more affordable.

2) Insurance companies will not be able to refuse coverage for pre-existing conditions or terminate a policy due to illness/injury.

I covered these and a few other not so trivial benefits in a post almost 3 months ago.

What we may not get at this point is a Public Option. I had previously surmised that as long as a Public Option was part of the House or Senate bills, it had a good chance to make it into the final reconciled bill. Even though the Public Option was included in the House bill, I am no longer very certain it will be in the final bill. As I said in that post, I still believe the Public Option, although a great rallying cry for Progressives, would have minimal impact. I think the White House knows this. I think they also know that they can accomplish many of the same goals (function) with different pieces of this and future bills (form) that will not have a bulls-eye on them.

Some progressives have called for running a strong public option bill through the reconciliation process, calling the bluff of opponents and making them try a filibuster or just abandoning this "watered-down" Health Care reform bill. However, one of the original and loudest proponents of the Public Option, Yale Professor Jacob S. Hacker, writes that this bill should be passed now.

I agree.

Once passed, it is unlikely to ever get overturned unlike a reconciliation bill which just expires after 5 years (like the Bush tax cuts).

It will be much easier to add and modify pieces to an existing bill as nothing will attract anywhere near the public attention, with quite so much misinformation and differences of opinion on impact as the current Health Care Reform bill.

This bill will not be good as some people want it to be.
This bill will not be as bad as some people fear it will be.
It is a start. A good start and long overdue.