Sunday, December 27, 2009

Should We Support the Senate Health Care Bill?

So the Senate finally passed a health care reform bill the morning of Christmas Eve. While the president hailed it as a landmark event, for many others who voted for President Obama especially because of his support for health care reform it was a bittersweet moment. Those who were hoping for real reform in the form of a public option or even a Medicare buy-in for those 55-65 years of age were disappointed to see the proposed bill systematically taken apart by various senators such as Joe Lieberman and Ben Nelson in exchange for their votes to reach the magic number of 60 to defeat the Republican filibuster that would have killed the bill.

Indeed, noted liberal commentator Keith Olbermann offered one of his
Special Comments which in effect said that the Senate bill was ruined to the point of being unsupportable. Before that former Democratic National Committee chairman Howard Dean said the same thing although he has softened his stance since then and said that he now reluctantly supports the bill.

There is a lot not to like about the Senate bill that was passed. For one thing, those of us without insurance coverage from employers would be required to buy health insurance from the private insurance industry under threat of a fine. Even worse, without any public insurance plan to compete, it is unclear what if any constraints there will be on premiums or if they will even be affordable to everybody. In an attempt to make the insurance affordable, federal subsidies will be available which in effect will amount to a massive transfer of tax dollars to the already wealthy insurance industry.

While the House which has a larger Democratic majority approved a bill that includes a public option and is much more reform-minded, the Senate cannot effectively pass anything with less than the 60 votes needed to avert a filibuster. And with the Republicans not offering a single vote in favor of the bill, the 58 Democrats and 2 Independents must all vote in unison or be defeated.

As NYT columnist Thomas Friedman has suggested, in the Senate we now have what can effectively called one party rule (the Democrats) in a two party system (with the Republicans serving as obstructionists) which makes passing needed legislation most difficult. Without any bipartisan support from the Republicans, the Democrats need absolutely all of their votes to prevail which means that tremendous compromises (which water down the bill) are needed to get the few stragglers such as Liebermann and Nelson to come on board.

The next step will be to reconcile the House and Senate bills to provide a single bill for both houses to vote on. While there are some who still think they can fight to reform the Senate bill into one more to their liking, the Senate stragglers out of the 60 who voted for the bill before have pledged that any changes would result in losing their support for the final bill.

So like it or not, we will most likely have to choose between the Senate version of the bill or no reform bill at all. For all of its warts, getting millions of people finally insured is better than no reform at all. Eliminating refusals to insure people for pre-existing conditions will be a major step forward for these individuals.

But how will this all work out? Will the insurance industry still be able to game the system to get the upper hand while too many people will still be unable to obtain affordable health insurance? The answer is probably yes. But if that happens, there is always the opportunity to pass legislation later on to try and correct those inequities. And it is true that Social Security and later Medicare first had gaps in their coverage that were fixed by later legislation.

While making these mid-stream corrections might well be difficult in this extremely polarized Congress, it’s a whole lot easier to work with an existing program later on than with no program at all which is what we have now. Especially considering that this is the best we can hope for with the Senate rules the way they are, the pragmatists amongst us who support health care reform have little real choice but to hold our noses and support this bill.

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