Why I Support The Health Insurance Reform Bill

Speaker of the House Nancy Pelosi

The interminable march towards health care reform (HCR) is continuing in earnest today, with an end finally (FINALLY) in sight.  So what is actually happening right now?  And what's this "reconciliation" business all about?  There's no good way to sum up parliamentary procedures into a bite-size format, so bear with me, as this email will be long.  

Procedural Issues

In brief, the House of Representatives voted today on the HCR bill passed by the Senate in December.  The Senate bill, as you may have heard, includes some rather unsavory deals that were cut in order to win 60 votes and to pass the bill; deals such as the "Cornhusker Kickback" that was negotiated by Sen. Ben Nelson (D-NB) that would provide indefinite federal funding to cover the expected increase in Nebraska's Medicaid costs due to expanding coverage to more people (Medicaid is paid for in part by federal funds and in part by state funds, so any increase in Medicaid costs will cost the states directly).  The Kickback and other deals that were made for specific Senators in specific states to win their votes are obviously not terribly popular with rank-and-file Democrats, and so by the House voting for the Senate bill as it is, they made those Senate deals into law.

However, over the last few weeks President Obama, Nancy Pelosi, Harry Reid, and other key Democrats in both chambers of Congress have worked out a deal to pass a reconciliation bill that "fixes" all of the deals that were passed in the Senate bill and that will work to further reduce the deficit (the Congressional Budget Office, the main non-partisan arbiter of all things budgetary, has stated that the bill will reduce the federal deficit by $140 billion over the first 10 years it is in place and by $1.2 trillion over the second 10 years it's in place, although those numbers are subject to a large amount of skepticism on both sides).  This reconciliation bill will be voted on tonight by the House once the Senate bill is passed by the House, and then that reconciliation bill is supposed to be passed by the Senate, hopefully later this week, although the timing is debatable.  Members of the House are afraid that the Senate will seek to alter the reconciliation bill, upsetting the delicate balance that has been struck between leadership and the members, although Senate leadership has worked to reassure nervous House Democrats that the Senate will pass the bill as-is.  Any changes that are made in the Senate will have to be voted upon again by the House before President Obama can sign the bill, delaying the legislation further, an outcome Democrats are working to avoid.  

So is the use of reconciliation by the Democratic majority "unconstitutional" or a "nuclear" procedure, as Republicans have sought to portray it?  Well, considering that the majority of the uses of reconciliation have come when Republicans were the majority in Congress (16 out of 22 reconciliation bills) it seems a bit rich for Republicans to call it an extraordinary procedure now.

Finally, abortion.  A lot of hay has been made in the last few weeks about whether there is any federal funding of abortion in this HCR bill, and the fact is, there never was any federal money for funding abortions.  There is a provision in the House called the Hyde Amendment, that bans spending federal money on abortions, and the HCR bills that have been debated have always upheld that provision.  It has now been reported that President Obama has issued an Executive Order banning the use of federal money on abortions, as an extra safeguard, so thankfully, this argument is now moot.

Why I Support The Bill

The primary reason that I am in favor of passing this bill, despite the fact that it does not include the most effective cost-saving measures of either a public option or single-payer system, is that the bill enshrines in US law the fundamental concept that health care is a right, not a privilege.  For too long in this country, we have consigned our fellow Americans to suffer from treatable, often preventable illnesses and conditions by claiming that people have the "choice" to buy health insurance if they want it.  Sadly, the reality has never been quite so simple.  Two of the more significant reforms in this bill are those ending the denial of health insurance for those people with pre-existing conditions, and making illegal the use of rescission (where the insurer cancels your health insurance just when you need it most due to a usually dubious claim of "fraud" on your insurance application).  These two revisions alone will help keep far fewer people from going bankrupt due to medical care (click for shocking statistics).  

Consider the fact that if you receive your health insurance through your employer, as the vast majority of Americans do, what will you do if you lose your job?  You will have COBRA coverage for a few months, but generally COBRA is quite expensive, and moreover, it's temporary.  How many of you who are lucky enough to have jobs still are unwilling to leave a job that is no longer satisfying because you are afraid of losing your health insurance?  Is that lack of mobility not an impediment to your freedom?  Does not the health insurance system we have now foreclose upon choices that we would otherwise have if we were assured of health insurance?  Far from reducing our freedom as many opponents of the bill have claimed, this bill will greatly enhance freedom and will enhance job mobility.

For small business owners and entrepreneurs who would like to start out on their own, but are not able to afford exorbitant health insurance costs, this bill provides subsidies for health insurance for their employees.  Whereas the current system has skewed the benefits towards existing companies, and especially towards companies with large employee bases that can be insured under group plans, this bill begins to level the playing field between newer and more-established businesses, and between larger and smaller businesses.  

As a young person, I will be paying for this bill for the rest of my days, and despite that (in fact, because of that) I still support it.  I have faith that the bill will be improved, refined, expanded, and remade in time.  Young people are the linchpins upon which reform depends.  The reason we have coverage mandates in the bill is so that younger, healthier people (who tend not to buy health insurance) will be forced to buy insurance.  Younger people tend to have better health than the not-as-young, and because of that, it is unlikely that a young person will spend as much on health care as they pay in annual premiums.  The idea is that the insurance companies will shift those excess premium dollars (after shaving off a nice profit) to pay for more expensive people's health care, who may have spent more on care than they paid in premiums.  So they need us, which is a reason why the HCR bill has a provision that allows dependent children to be covered under their parents' health insurance plan until they're age 26.  As long as somebody's paying the premiums for their insurance and not costing insurance that much money on care, the insurance companies are happy.

Finally, I support this bill because even if you have insurance and you're happy with it, you already are paying for the uninsured.  In fact, you're paying quite a lot for the uninsured, and it'll only get worse unless something is done.  When a person does not have health insurance and gets sick, they'll probably wait until they're really sick and then go to the emergency room for treatment.  As everyone is surely well aware, emergency room treatment is the most expensive kind, and when patients can't pay the hospitals back for the care they've received, the hospitals then charge insurers more for patients with insurance, which leads to higher premiums for insurance, which more people can't pay, and so they become uninsured...the cycle goes on.  This bill is an attempt to stop that cycle.

It's not perfect by any stretch of the imagination, but this bill is far, far better than the status quo.  For more information, see the two links below, both by the non-partisan Kaiser Family Foundation's Health News:

The Immediate Effects of The Health Reform Bill

A Consumers' Guide to Health Reform

More Highlight Videos from the Health Care Summit

I had said yesterday that President Obama came off well at the summit, and that the health insurance reform bill is actually quite moderate, and here's some video proof of that:



Yes, I'm a policy wonk, but this is a fascinating exchange, and well worth the 7.5 minutes to watch.  Obama explains just how difficult it is to craft reasonable health care regulations, since the government has to be responsive to industry concerns as well as those of individual consumers on what is an extremely personal topic.

Lastly, Speaker Nancy Pelosi courageously and valiantly stood up for the public option and called out Republican lies in regards to whether the reform bills allow for public funding of abortions and Medicare benefit cuts for seniors (neither are in either of the reform bills from the House or Senate.)  There have been egregiously misleading statements made about these bills by the GOP, statements that any person with an internet connection or access to a newspaper could very quickly refute, yet they continue to try to scare the public into opposition.  Bravo to Speaker Pelosi - see her in action below:

The Health Care Summit

So what happened today at the big health-care summit?  Democrats went to great lengths to express the reasonable aspects of their health insurance reform bill in the face of unified Republican derision to any discussion of reform that didn't have the word "tort" appended to the beginning of it (watch Sen. Dick Durbin dismantle the tort reform myth in the video posted below - fascinating).  The health care reform proposal that has emerged from the Obama Administration is actually quite a moderate bill (which includes many individually popular reforms within it) but you sure wouldn't know it from the Republican responses to the proposal.  To sum up in a few words, the Republicans demanded that the Democrats start over with a "clean sheet of paper" (code for "adopt Republican ideas or else") and that they reduce the length of the bill from its current circa 2,500-page length.  When President Obama released a condensed 11-page outline bill earlier this week, however, House Minority Leader John Boehner (R-OH) called that bill "too short."  Republicans also claimed that individuals will be forced to pay higher premiums under the reform bill (the Congressional Budget Office flatly disagrees with this argument.)  Obama just can't win, it seems.

So what's next, given that the philosophical differences that have been apparent for months between the parties are still clear as day after the summit?  Well it appears that Democrats are gearing up to pass the bill with a majority vote (reconciliation is the technical term) without Republican support of any sort.  I say great, let's put this behind us and get on to finding ways to create jobs in this country again.

Here's a compilation of the day's highlights (since I presume nobody had the time to watch all 7.5 hours):

The Upside of Scott Brown's Election...

Image via Wikipedia

...the Democrats in the Senate have finally been freed of having to seek the ever-elusive "60th vote" to pass health care reform.  I had discussed the reconciliation process a few months ago, but it finally seems that Harry Reid is prepared to use a majority vote to pass health care reform, regardless of what the "moderate" Democrats say.  By losing the 60th seat in the Senate, Democrats have been forced to seek other methods to pass legislation than negotiating with their own corporate-owned members (see Ben Nelson, Mary Landrieu, Joe Lieberman, etc.) and this has led directly to using the reconciliation rule.  So this week a major push has been made by a range of Senate Democrats to include a public option in the reconciliation bill, with Senators from Dianne Feinstein (pretty moderate) to Chuck Schumer (former head of the Democratic Senatorial Campaign Committee during the 2006 and 2008 elections, who is widely regarded for his political acumen) signing on to the letter to Majority Leader Reid.  But hold on a minute, isn't the public option a HUGE LOSER among the public?  Don't Americans want less government intervention?  Well, not really, it turns out.  A poll of Nevada voters released yesterday contains some stunning revelations - 56% of Nevada voters favor "the national government offering everyone the choice of buying into a government administered health insurance plan" versus 38% opposed.  Nevada, if you'll remember, was a major battleground state in the 2008 election; after being solidly Republican for many years (with a strong Libertarian, anti-government streak to boot) President Obama prevailed there in the general election, so Nevada's a pretty good bellwether state through which to gauge the national mood.  The poll also has implications for Harry Reid's reelection prospects, as he is not doing too well in polling in his home state, so a strong move to pass Democratic legislation could in fact help his prospects in Nevada.


We will see what happens, and I'll try to be a bit better about posting timely information, as health care reform continues to provide lots of twists and turns to keep track of.

The Bipartisanship Myth

I have noted before that Cenk Uygur of The Young Turks is one of my favorite bloggers out there.  But tonight, reading his latest posting on the Huffington Post, he hit the nail on the head when discussing the Democrats' love for "bipartisanship" in all things, but especially in the health care and financial reform debates:

And the Democrats are perfectly happy to [compromise] because they take the same, if not more, amount of money from those same corporate lobbyists [as the Republicans]. Except they have the meddlesome problem of pretending to be for the people. Republicans are not burdened with this; everyone expects them to help the rich and the powerful. But the Democrats need cover, and they have the perfect excuse in the mantle of bipartisanship. What could they do, the Republicans made them do it! And aren't they so reasonable for compromising?

I highly recommend reading the entire article, as it neatly lays out just how it is the Democrats have managed to accomplish very little of substance despite having the largest margins in decades in the Senate and the House, not to mention the Presidency.  There is a perpetual balancing act among American politicians of between being a good member of one's political party and engaging in electoral self-preservation (often at the expense of one's party).  At the same time, the campaign finance system that is currently in place makes it highly profitable for politicians to kowtow to corporate interests for their own personal gains (in the form of campaign contributions and favorable "issue ads" being run in their districts).  Similarly, the national committees of the two parties also have incentives to keep their corporate sponsors happy, as the corporations will then provide more donations to the parties who will then cultivate and fund the campaigns of more mini-corporatist candidates in elections around the country.  So in this context, the corporate line is the party line is the individual legislator's line - the corporation wins every time, since the corporation's interests are everywhere reflected in our political system.

This truth of government by corporation is nowhere more evident than in the recent Supreme Court decision Citizens United v. Federal Election Commission.  One does not have to look far to find strong reactions to the 5-4 majority ruling and opinion in that case, but the overwhelming consensus is that the Supreme Court has effectively granted US citizenship to corporations, with every faculty intact but the right to cast a vote for a political candidate.  I am rather tired tonight, and not in the best position to discuss the implications of this case fully, but let me say this: corporations exist for no other reason than to make a profit.  That is their sole motivation.  While corporate interests have been donating to politicians (and hence altering their political calculations) for years, Citizens United gives those interests expanded rights to pursue their ends through political channels, rather than through competition in the open marketplace.  This ruling creates incentives for corporations to find the politicians who will do their bidding most effectively, rather than spend more money on R&D to improve their product or service.  The ruling also creates incentives for politicians to be the most effective advocates for their corporate sponsors that they can be, regardless of the effects on the public at large.  The money is, in effect, divorcing us from our elected representatives.  This is nothing particularly new, mind you.  But these activities have never in our country's history been given such explicit sanction by our highest court, and the effects have the potential to be disastrous.

Elections have consequences, and those consequences are often most apparent in the makeup of the Supreme Court, where justices have lifetime appointments.  We need a lot more Sonia Sotomayors to make up for this ruling.