Blue Mass Group

Reality-based commentary on politics.

Pass the Healthcare Bill

By

Cross-posted from Blue News Tribune.

Just do it.

Yesterday, I wrote that a bad bill is the worst possible outcome. I’ve changed my mind.

Even Howard Dean, speaking on On Point on WBUR yesterday, said the Senate bill does some good things. OK, then. Let’s take it.

I’m not crazy about the mandate; it’s an imperfect solution. Some have said it will be a windfall for insurance companies. But you know what? Health insurance is not all that profitable. It’s a business that looks like a cash cow from the outside – like, say, a ski resort, when all you see is person after person shelling out nontrivial cash to ride down a hill. But then you look a little closer and consider all the administrative costs and all the regulatory issues and all the payouts, and it’s a lot less profitable. The real profit drivers at insurance companies are their investment portfolios. Are insurance CEOs overpaid? Of course. Are they more overpaid than automotive or technology CEOs? A harder question.

So then the question is, do we accept an imperfect bill? Yes, for a simple reason: We’ve been here before, and we failed. We’ve got a far better chance of a more perfect bill later (we will never have a perfect bill) if we have an imperfect bill now. If we have no bill, we reinforce the invincibility of the status quo. We send a message to the GOP: we have no will and no power. You can stop us. We will defeat ourselves without your help.

It’s not single-payer or a public option. It’s not what I wanted. It might not be what anybody wanted. But it’s something. Have we wasted 2009, or did we get something?

Health care is one-sixth of the American economy. We all know the stats: 37th in the world in terms of care; perhaps home to the greatest specialists; tops in cost; somewhere in the range of 45 million uninsured Americans; long waits for appointments. The system is broken. Of all the metaphors that come to mind, all imperfect in their way, the one I think fits best is urban renewal. If we try and fix everything at once, we will fail. Can we fix the broken windows? Yes, we can. And we should.

I will take a small success over total failure any day. Maybe this bill will turn out to be a total failure – but we don’t know that yet. Either we go into next year with something done that can be tweaked, or something not done.

The cliché is, “Don’t let the perfect be the enemy of the good.” I hate that expression, because it is nearly always used to beat someone with high aspirations over the head. I hate half measures and incrementalism. Sometimes I hate the U.S. Senate. But there is one thing I hate more than all of those combined: inertia. A willingness to give up, and just not try to fix things because they’re too hard.

Fix what you can. Move forward. Something is always better than nothing.

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Comments

  1. The individual mandate was bundled with single-payer/public option as two parts of a whole. An individual mandate without even a public option is nothing but a government-enforced windfall to the health insurance industry.

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    p>Strike the individual mandate, and I’ll support it. As it now stands, absolutely not.

    • OK, this is a good point to ask it straight up: how do you think the new insurance regulations in this bill (including the pre-exisitng conditions piece, premium equalizations, etc.) would operate without the individual mandate? Do you agree that premiums for the insured would rise significantly with healthy people (those waiting to get sick before getting insurance) out of the pool? If not, why not?

      • Originally published at AlterPolitics by Stan (AKA TheCallUp)

        New results from a national poll, conducted by Research 2000 between December 16 and 17, reveal that a majority of American voters are now AGAINST each and every aspect of the Senate’s ‘Obama-Lieberman’ health care bill – which President Obama is now urging for a quick passage.

        The questions asked follow:

        1. PUBLIC OPTION: Would you favor or oppose creating a public health insurance option administered by the federal government that would compete with plans offered by private health insurance companies?

        All Americans: 59% FAVOR, 31% OPPOSE, 10% NOT SURE
        Democrats: 88% FAVOR, 9% OPPOSE, 3% NOT SURE
        Independents: 57% FAVOR, 29% OPPOSE, 14% NOT SURE
        Republicans: 24% FAVOR, 64% OPPOSE, 12% NOT SURE

        So naturally, the Obama-Lieberman health care bill offers: NO Public Option.

        2. PUBLIC OPTION + MEDICARE BUY-IN: If Congress proposed passing a strong public health insurance option PLUS allowing people age 55 to 64 to buy into Medicare, would you favor or oppose this idea?

        All Americans: 58% FAVOR, 31% OPPOSE, 11% NOT SURE
        Democrats: 88% FAVOR, 8% OPPOSE, 4% NOT SURE
        Independents: 57% FAVOR, 27% OPPOSE, 16% NOT SURE
        Republicans: 22% FAVOR, 69% OPPOSE, 9% NOT SURE

        So naturally, the Obama-Lieberman health care bill offers: NO Public Option + NO Medicare Buy-In.

        3. MANDATE – NO PUBLIC OPTION, NO MEDICARE BUY-IN: Would you favor or oppose a health care bill that does NOT include a public health insurance option and does NOT expand Medicare, but DOES require all Americans to get health insurance?

        All Americans: 33% FAVOR, 56% OPPOSE, 11% NOT SURE
        Democrats: 37% FAVOR, 51% OPPOSE, 12% NOT SURE
        Independents: 31% FAVOR, 57% OPPOSE, 12% NOT SURE
        Republicans: 30% FAVOR, 61% OPPOSE, 9% NOT SURE

        So naturally, the Obama-Lieberman health care bill includes: A Mandate with penalty, but with NO Public Option + NO Medicare Buy-In.

        4. OBAMA vs LIEBERMAN: President Obama has said he favors a public health insurance option. Senator Joe Lieberman is widely credited with forcing Senate Democrats to take the public option off the table in order to win his vote. Do you think President Obama should have done more to pressure Lieberman to allow the public option to move forward?

        All Americans: 63% FAVOR, 29% OPPOSE, 8% NOT SURE
        Democrats: 87% FAVOR, 10% OPPOSE, 3% NOT SURE
        Independents: 72% FAVOR, 18% OPPOSE, 10% NOT SURE
        Republicans: 13% FAVOR, 76% OPPOSE, 11% NOT SURE

        So naturally, President Obama – who was awarded a clear mandate for meaningful CHANGE from the people of the United States – pressures his party to defy the will of the people and bend over for a single politician, Joe Lieberman, who takes a staggering amount of money from the health insurance industry.

        What this poll reveals is that our government is no longer functioning as the democracy it was intended to be. When the will of a clear majority of the people, including a staggering overwhelming majority of the President’s own party, are being undermined so brazenly – as shown above – it tells you that special interests have successfully hijacked our government.

      • Please see this comment, together with my suggested extension.

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        p>The fact that we need everybody in the pool (most especially, mostly-healthy young people who can least afford to pay premiums) is why government-operated single-payer is the only approach that works.

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        p>The reforms in the current bill, without a mandate and without a public option, likely will cause premiums to rise significantly — demonstrating that private health insurance DOES NOT WORK.

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        p>When millions of American voters have first-hand experience with government-sponsored single-payer health care that works, and simultaneously face skyrocketing premiums for private health insurance coverage, the political tide will turn towards the right solution.

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        p>This is a gradual approach where the desired outcome emerges from a shift in the underlying electorate. It will be very hard for the lies of the GOP to gain traction in an electorate that has first-hand positive experience with a government health care program that works.

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        p>The result will be an electorate that demands universal government-sponsored single-payer health care in the 4-6 year time frame. That’s good social policy, good economics, and good politics.

        • Absolutely I’d agree that ultimately, the most sensible system is to end employer-based health care by achieving a single-payer system (as many other industrialized democracies have done quite successfully), and also change the fee-for-service model currently in place. I hope and expect the progressive community to push further in this direction as soon as this health care bill passes.

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          p>In the meantime, the (large) additional subsidies provided by this bill WILL mean more people in fact have essentially government-provided health care, which is at least a step in the right direction. Republican attempts to dislodge these subsidies in future years will backfire on them, just as it does when they try messing with existing broad-based social programs.

  2. They say that 33% support the current proposal of mandate without public option while 59% support mandate with public option.

    • Only 33% of voters approve of the Senate’s current plan to pass a bill without a public option but with a mandate forcing Americans to buy insurance.

      The good news is the poll shows Democrats the roadmap to victory:

      59% of voters still support a healthcare reform bill with a public option.

      Click here to contact your Senators.

      • I have contacted both Kerry and Kirk, told them no mandate unless there is a public option.  Would everyone please contact the Senators and then report to Neil that you have done so.  
        P.S.  Thanks Neil, I’ve been meaning to send off that email and kept putting off. Your right, now is a good time to do so.

  3. A message to progressives: By all means, hang Senator Joe Lieberman in effigy. Declare that you’re disappointed in and/or disgusted with President Obama. Demand a change in Senate rules that, combined with the Republican strategy of total obstructionism, are in the process of making America ungovernable.

    But meanwhile, pass the health care bill.

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    p>Honest to God, some of my best friends, who are usually pretty savvy politically, are using the same logic as the “old leftie” types used to justify voting for Nader.
    and when so accused say……….

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    p>them :”no, wait a minute, really, I’m not really, I’m just so mad that Obama won’t…………sputter sputter

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    p>me: “won’t what”

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    p>them “won’t stand up to them and make them do what he wants to do”

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    p>me:  stand up to who?

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    p>them: the drug manufacturers, the docs, the hospitals, the health insurance industry, the business community, organized labor, members of congress, aarp, seiu    

    <

    p>me oh — them — (btw aarp and seiu are mad they didn’t get everything they wanted but they think congress should pass the bill.)

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    p>them: oh they’re just pandering because it’s good for their members. What about Adrianna Huffington?

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    p>me: she’s just pandering for her liberal blog    

    • I think I’ve offered specific objections to specific and real problems with the proposed legislation. I think I’ve supported real and concrete alternatives that reflect my preferred approach (including my comment above).

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      p>I think your attempt to compare my posture with the “them” in this exchange is (perhaps inadvertently) insulting — far more so than I’m accustomed to seeing from you.

      <

      p>I think there are sincere and substantive problems with the health care bill as it now stands. I encourage you to rethink your posture towards me and participants like me in this community.

      • I know you have sincere and substantive problems with the bill as it now stands. I share most of them, and have communicated my opinion to my Congressional delegation, and hope and pray (really) that they can figure out a way to make the final bill stonger.

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        p>I wish there were more Members of Congress who shared our progressive analysis and committment.

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        p>But most of all I wish Senator Kennedy were still around to help us all to appreciate and value the final not perfect bill that will still help millions of people, and then lead us all into a 10 year campaign to make it more perfect.

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        p>Actually, improving a final health care reform bill is more like a life sentence without hope of parole.

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        p>I’m up for it, and I hope you are too.

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        p>  

      • No offense ‘BrooklineTom’ but you are not a member of Congress and no one is listening to your alternatives. If this bill fails, we will have a Republican House and a Republican Senate and believe me none of those guys will ever revisit the health care issue, and they will do even more to obstruct a progressive agenda. The long term solution is to elect better Democrats, Ben Nelson, Landreiu, and Lincoln are all in deep red states so they can be forgiven for their votes. Joe Lieberman can certainly be replaced by a progressive, and he should be. Similarly I think Harry Reid can be replaced by a more progressive and more savvy majority leader. But those changes will only benefit us if we are still in the majority. We pass this bill, we still have a majority, and we can still revisit the issue down the road. As Nate Silver, our own dear Charley, and Paul Krugman all point out this bill is still the largest subsidy to poor and working Americans we have seen since before the Reagan Revolution. The public is still broadly supportive of future progressive reforms. We can still pass a better bill in the future. If we fail to pass this bill today, we are left with giving the Republicans a huge stick to beat us with and to steal our majority, and then what do we have?

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