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Health Care: Time For Obama to Cross the Rubicon

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Joanne98 Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jan-25-10 04:25 AM
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Many people are lamenting the apparent death of the health care bill in the aftermath of Scott Browns unexpected election to the Senate last week. They shouldnt be. Congress and the President should use the opportunity afforded by the loss of Ted Kennedys seat to reconstruct a more sensible piece of legislation which genuinely addresses the real problems posed by our current health care system.

Senate Democrats in particular should not obsess about the number, 60. The absence of a so-called super majority of Senators does not preclude the possibility of passing significant health care reform, even the approach is ultimately more piecemeal and incremental. There is still ample opportunity to implement legislation in the Senate via reconciliation (a parliamentary maneuver which allows legislation to pass with a simple majority vote). And its fundamentally more democratic: 2 or 3 Senators should not be able to hold an entire piece of legislation hostage to their own narrow political interests, as Senators Lieberman and Nelson, amongst others, were cynically able to do under the previous legislation.

In response to the incrementalists Paul Krugman has argued that it is difficult to achieve significant health care reform via reconciliation, as this Senate procedure is basically limited to matters of taxing and spending, and therefore cannot be used to enact many important aspects of health care reform (such as the ban on pre-existing conditions) What Krugman fails to recognize is that the current incarnation of the health care bill would have done nothing to stop the abusive denial of coverage on the basis of pre-existing conditions, as Yves Smith and I have previously highlighted.

Krugman also embraces the principle flaw inherent in the whole health care reform effort. Both the House AND Senate versions of the bill entrench the centrality of private health insurance companies. But health care is not a service that should be provided by private health insurance companies, as L. Randall Wray has pointed out:

Most health reform proposals would somehow insure many or most of these peoplemostly by forcing them to buy insurance. All of them have pre-existing conditions, many of which are precisely the type that if known would make them uninsurable if insurance companies could exclude them. While it is likely that only a fraction of the currently uninsured have been explicitly excluded from insurance because of existing conditions (many more are excluded because they cannot afford premiums)but every one of them has numerous existing conditions and one of the main goals of reform is to make it more difficult for insurers to exclude people with existing conditions. In other words, reform will require people who do not want to buy insurance to buy it, and will require insurers who do not want to extend insurance to them to provide it. That is not a happy situation even in the best of circumstances.

Contrary to what the President suggested last week, bad salesmanship was not the main problem with this bill. There were lots of unattractive substantive elements, such as reductions in spending on Medicare to pay for the bills reforms, misconceived taxes on Cadillac plans to reduce health care costs and fund reform, a focus on costly end of life care (requiring guidance from an independent group outside of normal political channels), and a loophole big enough to drive a truck through in regard to the prevention of denying health insurance coverage on the basis of pre-existing conditions (which is why the 150,000 strong nurses union ultimately opposed the bill). All of this occurred against the backdrop of vague, incomprehensible talk by the President and his budget director, Peter Orszag, about game changers and curve-benders, and arguments that were going to have to change how doctors think about health care and how patients think about health care. These are the sorts of things that can be happily debated in a health care symposium, but will hardly ease the fears of the average voter, whose main concerns are: Will I get coverage? and How much will it cost me personally?

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