STOP. THINK. GO BACK.
I support health care reform. Not most of what the Democrats have been pushing as “reform,” but I agree that the system needs serious overhauling.
We need to insure those who want insurance but can’t afford it. We need to insure those who can’t get insurance, who need insurance, but are denied coverage because of a pre-existing condition. We desperately need to put downward pressure on the cost curve for health care, not only for those with private insurance but for those who are in government programs.
And we need to reform Medicare and Medicaid or we will go bankrupt.
The question is, to my mind, how much “reform” should we be attempting at one time, and whether the process we are witnessing now will make things better or make them worse.
It is things like this that have convinced me that we are legislatively overreaching on reform and that it is an impossibility that this process will produce a bill that will make things better:
Democrats on the Finance Committee, citing a Committee precedent, argued that the Baucus bill was more understandable in conceptual language than in legislative language, and pointed out that the Baucus bill was never more than one of two bills informing the final product in the Senate – that new bill, which merges the Finance bill with the more liberal HELP Committee bill, is being written behind closed doors.
Baucus, lead HELP Democrat Chris Dodd and Senate Majority Leader Harry Reid are set to meet this evening with representatives from the White House to chart their progress.
In other words – the Finance Committee worked for months to create a bill, which was then set aside as Democratic leaders went about writing it all over again.
The fact that the Baucus bill has been shelved as Democrats go about the bill merger process did not keep some poor soul at the Committee office from having to take the Baucus bill’s conceptual language and turn it into legislative language.
The result, with larger font and margins and double spacing, swells the product from 262 pages to 1,502.
As the article points out, the Baucus bill is deader than a mackerel, although I have no doubt some compromises worked out with moderates will survive - at least until conference committee.
But seriously, what can you say about a process that produces such a behemoth? I do not hold out much hope that the final product produced in conference will be much shorter. In fact, I think there’s a great chance that it will be even longer, even more complicated.
The reason for the bill’s length is that so many compromises had to be made and tidbits added to accommodate individual member’s concerns on the committee. What do you think a final bill will look like that will have to accommodate the many factions in the Democratic caucus? Some of the issues will have to be finessed in order to cobble together a majority. The potential for confusion and even contradiction is self evident in this process which leads me to the thrust of my objection.
The Congress is abdicating its legislative responsibility by overreaching on health care reform. There is no possible way that any member will be able to know what exactly is in the final bill, nor can we expect any member to be able to intelligently examine the legislation in order to come to a rational decision on whether they should vote for it or not.
Essentially, the Congress is throwing up its hands and tossing the health care reform bill into the laps of bureaucrats. It is they who will have to take this monstrosity and write the regulations that will govern 1/6 of our economy - all the players, the companies, the boards, agencies, departments, programs, and people who will have to deal in the real world with what Congress has wrought.
Now, to give bureaucrats their due, I’m sure they will do the best job they can, according to their lights, in interpreting whatever mess the Congress throws at them. I have no doubt that most are public spirited folk, patriotic and hard working, and very good at what they do.
But that’s beside the point. We didn’t elect bureaucrats to make law, we elected our representatives to do that. And the process we are witnessing on health care reform is not lawmaking, it is horse trading. The concepts, and mandates, and radical changes being proposed in the insurance industry are absolutely unprecedented and nobody - repeat, nobody - knows how any of it will play out in real life. Nobody knows how these changes will affect individuals. Nobody knows if the bill, in its totality, will help bring down costs or send them skyward.
Given the intimate, vital nature of reforming a system that is responsible for the life and death of 300 million people, don’t we owe it to ourselves to be as careful, and as thoughtful as possible? I challenge anyone to prove that the process we are witnessing now is “careful and thoughtful.” It has become a process not to reform health care as much as it has morphed into a process to get something - anything - passed.
As an historical example, take Reagan’s massive tax bill. That bill also ran over a thousand pages. That bill also became an exercise in vote trolling as member after member put in their little goodies, payoffs to get their votes. “A Christmas tree” was the way it was described. Budget Director David Stockman remarked “the hogs were really feeding.” All that extra horse trading resulted in a massive increase in the budget deficit and a tripling of the federal debt when both Reagan and the Congress refused to make the budget cuts necessary to get spending under control.
But that was just money. Now we’re talking about the quality of ordinary citizen’s lives not to mention actual life and death decisions. This is why the best possible outcome of all this would be failure.
Scrap comprehensive reform and rework a bill that would address some Medicare cost issues as well as perhaps opening insurance exchanges at the state level where risk could be pooled and policies sold at reasonable prices to those who want and need insurance. This could be done by offering everyone the opportunity to purchase bare bones plans that would protect them from catastrophic illness, while also selling more comprehensive plans tailored to specific needs. Perhaps these plans could be subsidized so that their cost was reasonable. Also, the idea of using Medicaid to insure some of the uninsured should be seriously examined - as long as states weren’t left holding the bag on costs.
Since Obamacare sets such a low benchmark for success (CBO says the HELP plan would still see 17 million without insurance in 10 years), such a series of small, but significant reforms would address two vital aspects of the problem while getting the ball rolling on comprehensive Medicare reform.
The state exchanges would not be easy to set up, but much easier than the public option. Medicare reform will be politically tough but its got to be done anyway. Perhaps incremental reform is the answer there as well.
I just can’t see any bill emerging from this process being anything except a real world nightmare for our health care system. That’s why I think it time to…
Stop. Think. Go back. Won’t happen, but it should.
Neil Stephenson’s Baroque Cycle is over 3,000 pages. The Lord of the Rings around he same, yet somehow Peter Jackson managed to read, decipher it’s meaning and translate it to the big screen.
What difference does the page count of the bill make? Seriously?
Comment by Richard bottoms — 10/20/2009 @ 11:33 am
So you visited the sausage factory and were surprised they were grinding up tails and snouts and unnamed organs?
In a perfect world — no, not even perfect, just rational — we’d be looking seriously at larger changes, not smaller ones. As Dave Schuler convincingly and persistently argues, we need fundamental changes in the incentive systems built into health care, and we need to increase the supply of health care providers in order to drive down costs.
We need a lot of big changes. But we can’t do things that way because the Democrats are half in the bag for the health insurers and doctors and hospitals and the Republicans have decided that their sole contribution to democracy will be repeated expressions of contempt for Mr. Obama.
It’s a swell combination: a party of corrupt, gutless simpletons on one side and a party of nihilist loons on the other.
Comment by michael reynolds — 10/20/2009 @ 11:34 am
The party of gutless simpletons gave the country Medicare, Social Security, and Medicaid so I am betting that between the two the Democrats are more likely to deliver a system that is intended to work.
At least the Democrats start from the premise that government can work and try to reach a good outcome.
The GOP believes government cannot be run efficiently or well, and they set out over the previous eight years to prove it.
Comment by Richard bottoms — 10/20/2009 @ 11:47 am
Richard:
That’s why I’m a Democrat: I prefer corrupt, well-intentioned simpletons to batshit race-baiting nuts.
I’m pretty sure that’s what the Founders were going for.
Comment by michael reynolds — 10/20/2009 @ 11:55 am
Now, to give bureaucrats their due, I’m sure they will do the best job they can, according to their lights, in interpreting whatever mess the Congress throws at them. I have no doubt that most are public spirited folk, patriotic and hard working, and very good at what they do.
I’m not quite as optimistic about you on this point. I think bureaucrats have just as many ideological axes to grind and agendas to push as politicians, their just less accountable to the voters. The whole idea of non-partisan is a bit to dreamy.
Overall I think we’re in trouble no matter what happens with healthcare. Given the current moral climate and large bill is going to be full of massive pork and excess which could make things much worse. I wish they would stop, think, go back.
“The best laws cannot make a constitution work in spite of morals; morals can turn the worst laws to advantage.” - Alexis De Tocqueville
Comment by Public Freedom — 10/20/2009 @ 12:26 pm
Rick,
I thought this was a pretty interesting post. I’ve noticed that you’re quickest to comment in here when someone takes an assholish tone. I’ve done that. (Not that you’re a resevoir of gentility either - not that you’re obligated to be, nor am I) Anyway, the preamble here is an alternative to try to draw you to answer, instead of anger.
That’s not really why I’m doing it - this post also just doesn’t anger me. I get angry at intellectual dishonesty and blithe dismissal of serious problems - which is most of what conservatives offer on health care. Tax breaks or HSA’s don’t do jack diddly for low-income (but above Medicaid) folks. We pay little federal income tax anyway (although we pay plenty of state and local taxes & payroll taxes). There’s nowhere near enough income taxes left to do a dime’s worth of difference on health care costs that will instantly bankrupt us.
You’ve admitted the problem, which is a good start. I thought you were as ignorant on this issue as most conservatives when I commented on this last time - you demonstrated that I was wrong.
So you know some things, but you make inexplicably weak arguments.
How can you base how messy a bill this is on its length? It’s a complete straw man. The Senate doesn’t write legislation in this manner because making your bill 1000 pages long is fun. They do it because if you don’t dot every I and cross every T, the law will be nullified by smart lawyers in 300-page court decisions. Or, in the exact opposite of your suggestion, it will be forced by not being 1000 pages to fail to explain how it should be reconciled with previous 1000-page bills. THAT!! is the moment when the law’s intent can be most easily manipulated by bureaucrats.
However, thank you for, again, breaking with dishonesty and bullshit by not avoiding the truth that Reagan’s tax bill was 1000 pages long. It may have been a bad bill (I don’t even know if you’re reffering to the 1981 one or the 1986 reform, which most people think was pretty good), but its length had nothing to do with the massively deficit-introducing consequences. Nor did, for the most part, the favor-trading. The deficit exploded because he cut federal revenue by massive amounts while growing government spending faster than Jimmy Carter. Everything else is trivia.
So that argument makes no sense.
Furthermore, a bill like the one you support would ALSO have to go through this “highly confusing” process wherein Nancy Pelosi picks the bill she wants, Max Baucus rewrites the bill that makes you happy, and then they have to negotiate something in between while handing out the favors to compensate for their compromises.
If you don’t like it - I’m not thrilled with it myself. My suggestion would be to abolish the Senate and move to a unicameral legislature. Otherwise, every bill will be subject to the exact same twists.
By the way, there’s no way the Baucus bill is “dead in the water” unless “dead in the water” means “going to pass with at least half its provisions intact” or even “going to pass almost exactly as written, with some extra revenue chunks and perhaps a mediocre public option.
So, in conclusion - reasonable background view, but I don’t get the argument. You know, if you settled for being a conservative Democrat, you wouldn’t have to come up with complicated reasons to be angry at things you basically support.
You know as well as I do that most of the things you want out of healthcare reform are both in the Baucus bill and will be in the final version.
The only place you really disagree with a liberal like myself is the public option.
Your argument there is also very poor. I actually don’t like government for the sake of government, but there is absolutely no other way to provide any relevant competition in the market whatsoever.
Every state in the country is dominated by a near-monopoly or an oligopolistic cartel in the insurance market. For Pete’s sake, there’s an antitrust exemption, how else could it be?? Furthermore, the nature of risk pooling and the infinite advantage to scale in net liquid assets means that insurance should naturally be an, um, extremely uncompetitive market.
Futhermore, it’s also incredibly inelastic. When your health is seriously threatened, you must take the services. There’s no way to make demand fall, so prices can’t decline.
If you don’t get the insanely rapid rise in private health care costs to fall, you will never, ever, ever get Medicare costs under control. If Medicare payments get too far behind the private sector, the distribution network will collapse. Your choices are a) scrap Medicare or b) kill the constant rise in private health care and health insurance costs (200% in the last 10 years, I believe).
This bill is your only chance at that. The excise tax is a good start. A public option is a better one. The first one is a direct financial penalty to high costs. The second bands the un- and self-employed into an effectively organized interest group in a way that they will, never, ever, ever be able to do on their own.
How in the heck can you talk about the need to get Medicare costs under control, and not side with a bill cutting $400 billion out of Medicare?
Comment by glasnost — 10/20/2009 @ 9:32 pm
Not only that, but if congress “scrapped” this bill, your conservative movement would howl at the moon and convince the media that this means the public hates democrats, health care reform, and risks, and that they have no chance of passing another bill. Why would they? Scrapping a bill is interepreted as evidence that you are weak, and is also assumed to weaken you itself even further. Add on the ticking clock until the Midterms, and you know there’d be poor chances of another bill passing.
And if Republicans gain even one Senate seat, health care reform is dead until a Republican is in the White House - and they will of course go on to fuck it up (TAX BREAKS FIX EVERYTHING YAYYY!). The R Party isn’t filibustering this because of principle - they’re filibustering to prevent the President from any law people might like passing while he’s in office.
This is the only shot. There won’t be another. (Realistically, if a Republican Party did anything to deal with spending, they would scrap Medicaid).
Comment by glasnost — 10/20/2009 @ 9:42 pm
“Stop. Think. Go back.”
No.
You’re a little late Rick — the “let’s just stall and healthcare reform will lose its momentum” was getting old two months ago.
Just to satisfy my curiosity, how much “think” will make you comfortable with the outcome? How long has this been going through the “thinking” phase? How much longer will it be before anything is ready to make into law (if at all)?
Sounds like “Stop. Think. Go Back.” translates to “Stop. Think. Go Back And Do It The Way I Want.”
Comment by busboy33 — 10/21/2009 @ 1:48 am
“The question is, to my mind, how much “reform” should we be attempting at one time”
This is my view, we are overreaching and if we did this in small steps to bring things under control it would end up with something that people can see and accept, big dumb changes are something that everyone fears and gripes about afterwards. Just like ’shovel ready’ projects that never came to pass, at least in my area, I don’t think that this Administration and Congress can focus on some targeted reforms that would help and at least make a change that can be built on.
Comment by boyo111 — 10/21/2009 @ 6:04 am
PASS THE FAIR TAX PLAN HR-25 & S-1025
Comment by Chris Pedersen — 10/21/2009 @ 6:56 am
Amen, Chris.
Rick, “careful and thoughtful” just don’t apply to our Congress. They should, but unfortunately, they don’t–on either side of the aisle. At least not in any meaningful amount.
Comment by Kerri — 10/21/2009 @ 8:27 am