D-DAY FOR HEALTH CARE TODAY
No matter how the vote in the House on health care reform turns out, the amateur historian in me is tickled to be living in such “interesting times.”
I think that 200 years from now, this interlude in American history will be seen in the same way that we look upon the Missouri Compromise, or the nullification debates. More modern examples would include the Civil Rights Act and Voting Rights Act. The impact that all those debates had on the future of America cannot be overstated.
Even debates over New Deal or Great Society social legislation were muted and, in retrospect, not as controversial as the health care reform bill that is being brought to the floor today.
Never has such a large part of the American economy been designated for federal control. Never has the government reached so far into the personal lives of its citizens, compelling them through force of law to surrender some of their liberty. Every American will be affected by this bill in ways that not even the bill’s most ardent supporters can say with any certainty.
It is, as was said of the 1981 tax cuts, “a crap shoot.”
There is the potential for great mischief - a veritable smorgasbord of slippery slopes - some more realistic than others. There is the danger that the bill will not do what its supporters say it will do; lower costs and cover more people. There is the certainty that with the government now paying more for health care, they will feel it necessary to, if not dictate, then strongly encourage people through punitive tax laws to change what they consider “unhealthy” behavior.
I have written often over the last months that some reform is vitally necessary. The system is broken. Too many who want and need insurance are priced out of the market. Costs are rising at a ruinous rate and are sucking the life out of our economy. And some provision must be made for those with chronic or pre-existing conditions who are rejected by insurance companies.
Then there are the real biggies; We need to begin now to reform Medicare and Medicaid. There simply is no choice if we don’t want our economy to be destroyed.
But the bill that has been brought to the floor of the House today is far too ambitious in some areas, much too timid in others, way too expensive, and at bottom, an invitation for government to inject itself into the economic and personal lives of its citizens. The president and the Democrats have not made their case that this bill is the answer. Instead, they have made the primary goal of the process not the reform of health care, but a political yardstick by which to measure the president’s success. A failure is to be avoided because it would wound his presidency and damage the Democratic party’s chances for electoral success in 2010. Using that thinking, a bad bill is better than no bill at all - a recipe for unmitigated disaster.
This is not surprising because the monumental complexity of this bill makes it impossible to boil down into coherent policy. It is a slap-dash, confused, utterly incomprehensible mish mash of clashing interests, favors for industry, mandates for business, and the worst that nanny statism has to offer. It is too much for America to digest at once, and the best we can hope for is that the votes to pass it never materialize, forcing its withdrawal.
Despite the Democrat’s huge majority, chances for passage are still up in the air. That’s due to something that the president, in his health care reform speech, said was not in the bill but to no one’s surprise, ended up being included anyway; federal funding of abortions.
An agreement on language that would have set up an “independent monitor” to make sure that federal funds were not spent on abortion fell through last night - largely because the Catholic bishops, who are involved in the negotiations for this issue - wouldn’t support it.
Instead, Pelosi reluctantly agreed to a deal where Bart Stupak would be able to offer a floor amendment banning most federal funding for the procedure. It appears that this will satisfy a couple of dozen Democrats who will vote for the final package once the abortion amendment goes down to defeat.
According to Politico, that’s not nearly enough to assure passage:
“It’s a question of how you can keep everybody together and that’s the challenge before us,” Waxman said of the proposal earlier in the day. “What’s being called the Ellsworth language is also the bishop’s language which is the Stupak proposal. It’s basically to stop any services for abortion coverage in both the public plan and all private insurance. Not just for those who get subsidies but for everybody who goes to private insurance policies.”
“I would like the bishops, who I understand want to see passage of the legislation, to help us work out a way so we don’t have winners and losers,” Waxman said. “Because the losers will make us lose the bill and the winners then wont have won anything.”
Democratic officials said their count of hard “nos” was in the range of about 25. While House Speaker Nancy Pelosi can afford to lose up to 40 votes and still win passage, there are dozens of other lawmakers who remain on the fence publicly.
The last whip count had Pelosi at least 14 votes short, with no doubt a lot of fence sitters added to the “Yes” column. And that was for a bill with a “robust” public option. The abortion and illegal immigrant access issues weren’t even considered.
President Obama will come to the Hill today to twist some arms, and perhaps do a little horse trading with the fence sitters. Indications over the last month is that there may be as many as 60 Democrats who are very nervous about the bill, either because of abortion, or it’s ever climbing cost. No doubt many of them are open to blandishments from the White House. But in the end, it may be that there are just too many who won’t go along with the majority to realize passage - at least now.
It is possible that Pelosi will yank the bill from consideration today and delay the vote for a few days or a week in order to really turn the screws on recalcitrant members. But regardless of what happens, the thrust and parry in this debate has been one of the most fascinating exercises of democracy in our republic I can remember.
How it ends will determine what kind of country we will be forever after.
How it ends will determine what kind of country we will be forever after.
Or it won’t. Historians will have to give a patient explanation about the context, students will be forced to memorize the historical nobodies and their puzzling reasons for proclaiming the end of freedom, and the whole thing will be as lost as the dispute over Oregon’s border.
Perhaps. But think of what you learned about the Missouri Compromise. Sure, some of the chaff of the southern position on the bill comes down to us but the real issues are what survived. And of course, Henry Clay and his tireless efforts to save the union.
“End of freedom” is an exaggeration, I agree. But an “infringement on liberty?” I don’t think even the bill’s proponents will deny that there are negative ramifications for personal liberty when any kind of “mandate” is involved.
ed.
Comment by Modulo Myself — 11/7/2009 @ 11:59 am
I’m with Modulo. I think this is much ado about very little. Two years from now no one will even remember why people were so hysterical. The right wing’s reaction has been just weird, a tale told by idiots, full of sound and fury, signifying nothing.
You haven’t read the bill or don’t know what’s in it. The level of interference in people’s lives will be astounding - shocking. It’s not about health insurance or even “health care” like going to a doctor or hospital. It is the dozens and dozens of new agencies, board’s, and departments promulgating thousands of regulations that will seek to control - benignly or not - the behavior of Americans on a scale that was never imagined by anyone even a generation ago.
Why so sanguine in the face of this onslaught? I thought you were something of a libertarian.
It’s about narrowing or taking away choices. If that isn’t anti-liberty, I don’t know what is.
ed.
Comment by michael reynolds — 11/7/2009 @ 12:22 pm
“How it ends will determine what kind of country we will be forever after.”
Well don’t stop there. What kind of country will we be if it passes? What kind of country will we be if it does not?
Comment by Anon — 11/7/2009 @ 12:44 pm
But think of what you learned about the Missouri Compromise.
On a nice sunny Saturday afternoon, that sounds like a threat. But the Missouri Compromise was a political attempt to resolve an enormous concrete thing that in 1850 engulfed every aspect of American life. Slavery and racism were as important to America as the Constitution. I just don’t see actual anti-government sentiment as being that influential as an ideology.
The reality is that the right can gin up protesters only for future programs, while using quite factual claims about death panels, fascism, socialism, and worse, the future program’s inevitable assault on successful government programs, once protested with the same fervor and dire predictions as the one in the present.
If the right’s claim was that health care could improve, costs would be lower, but you would have to fill out ten, fifteen, or twenty more forms per year, and, because the left is totalitarian, see a doctor each year, and have to hear a lecture about cutting back fats, cigarettes, and single-malt scotch, then the attendance and outrage would be much less. People want good health, and they also are kind of aware that good health is not exactly an issue that aligns precisely with other freedoms.
And for most Americans, the health care system is a nightmare. Even if you have health-care, most people live with a state of anxiety about being treated as anything more than a simple number. The idea that government is going to move in, and take away the old country doctor and lollipops is ridiculous. It is already an onslaught.
Comment by Modulo Myself — 11/7/2009 @ 12:49 pm
It’s not narrowing or taking away my choices.
My choices have been narrowed and taken away by the free market. I’m self-employed, so I have to get my own health insurance. Something I have been unable to do because I’ve committed the sins of being 1) old and 2) taking Zocor.
My income, my lifestyle, my kid’s college, they are all in danger because your precious private insurers refuse to cover me as an individual.
So I’ve had to form a corporation and try to use that as a work-around. That has cost me thousands of dollars. It has cost me many, many productive hours. It is still costing me time and money and I’m not there yet.
I’m not even getting to the cost of health insurance, I’ll pay what’s necessary and fortunately have the means to do so. But I cannot get coverage.
I am hardly alone in this. Millions of us are denied coverage and left at risk of instant bankruptcy so that health insurance execs can fly around in private jets.
So please don’t tell me my liberty will be impinged. My only “liberty” right now is the liberty to lose everything in an instant.
The current system is an atrocity the evils of which are concealed by the fact that employers bear them and pass along the pain in depressed hiring and depressed wages. If it were up to me I’d have a single payer system and to hell with Aetna, Blue Cross and the rest of these criminal organizations with their rescisions, refusals, deliberate stalling and time wasting, absurd paperwork and utter dishonesty, all in the service of profit.
Until you have been out in the market trying to deal with these people one-on-one you have no idea what is going on.
Comment by michael reynolds — 11/7/2009 @ 1:01 pm
The tragedy of US education is that “My choices have been narrowed and taken away by the free market” is viewed by a large chunk of society as something other than nonsense in the context of US law in 2009.
Health insurance is a game of spreading risk over groups. The riskiest group is the individual and thus is going to be the most expensive. There are a number of enterprises, including the freelancer’s union which are open for trivial membership fees and allow you to participate in their group insurance. You also can incorporate for significantly less than $1000 by using one of the incorporation firms out there. A little google goes a long way in saving money.
If you make a mistake and think that the most expensive type of insurance out there is your only choice, your own pocketbook is hurt. When the government makes the same kind of mistakes, everybody’s pocketbook takes the hit. This is what we’re up against and while the money issues are nasty, we also have poorer health care because of the government interference we already have.
The government has been making these kind of mistakes for decades. Primary care physicians are compensated poorly compared to specialists. This is a government problem because if a private insurer were to ever be stupid enough to buck Medicare’s determination, they would get slaughtered. It’s a “parliament of clocks” issue.
The result of that mistake is that most become specialists and you get expensive, uncoordinated, inferior medical care. People have trouble finding a primary care physician and the primary care doc has to see so many patients to make ends meet that care is not as good as it could be.
Pro-government insurance advocates crow about Medicare and Medicaid’s low overhead rate but when my wife wanted to report a firm that was pressuring her to sign for house calls, scooters, and other covered medical services and devices that were not needed we couldn’t get the time of day from anyone. A million dollar fraud just wasn’t interesting enough to pursue our report, not enough anti-fraud personnel, my guess.
Comment by TMLutas — 11/7/2009 @ 4:01 pm
Michael Reynolds said:
I’d also like to add the immense joy one gets from having to battle an insurance company while your six year old lies dying in a hospital bed. If that doesn’t make you enjoy your liberty, you’re not a true American.
Comment by Chuck Tucson — 11/7/2009 @ 4:01 pm
Chuck Tucson - I’m sorry to hear about your child’s illness. I hope everything ended up ok. Now imagine the same battle but you’re dealing with a government agent who has legal immunity while you have nowhere else to appeal to. At least with private insurance, unwarranted denials can be appealed to the government insurance boards that can pull a license if the insurance company is acting illegally.
My wife’s grandmother was denied ambulance service for a broken hip based purely on age. They wouldn’t even take her to the hospital and told my in-laws to just light a candle and wait for her to die. That was in Romania, a government system that was end-stage. Fortunately, private ambulance services had been legalized by then and they just paid for her transport. They also paid for her hip prosthesis because the government hospital didn’t have the right plate to put in her hip. There was a pharma rep on the first floor and if you could pay for the plate, the government surgeon would put it in for you.
It took a long time for things to get that bad, 50 years. Just as I get to be an old, old man and really need my healthcare, the government system Obama/Pelosi/Reid want to put in place in the US is going to be falling apart. No thanks./
Comment by TMLutas — 11/7/2009 @ 4:09 pm
TMLutas:
The only reason I can incorporate and thus — maybe — get insurance, is because government, in the form of the State of California, has mandated it by law.
And really, spare me the “little Google goes a long way” bullshit. My time is valuable. It’s more efficient for me to pay a lawyer than to give up work time. It’s money wasted whether it’s my time or a lawyer’s time, just as it would be wasted money whether I had to do the accounting or used my accountant.
The many groups you imagine will offer me insurance are baloney. They tend to offer policies with too low a cap to do me any good. A quarter mil cap isn’t going to do it if my wife gets Alzheimers.
And finally, yes, I understand that insurance companies are only doing what they do best: pursue profit at all costs. Which is precisely why I like the government getting involved. Because I don’t really want to trust my life or my kid’s lives to people whose only moral standard is self-interest.
The one person whose medical care I don’t have to worry about his my father: he is covered by the government in the form of the VA. The lousy socialist.
Comment by michael reynolds — 11/7/2009 @ 4:30 pm
TMLutas:
Good lord, if anyone ever needs an example of Republican idiocy on this topic it’s your comment comparing Romania and the United States.
That’s right: we’re going to become Romania.
Not France, Netherlands, Germany, Switzerland, Sweden, Finland, Japan, Canada or Australia. No, our future is Romania.
Yes. That makes perfect sense.
Comment by michael reynolds — 11/7/2009 @ 4:34 pm
[...] This post was mentioned on Twitter by N00bJuice and Eric May, moment_um. moment_um said: D-DAY FOR HEALTH CARE TODAY: http://bit.ly/16w3S1 via @addthis [...]
Pingback by Tweets that mention Right Wing Nut House » D-DAY FOR HEALTH CARE TODAY -- Topsy.com — 11/7/2009 @ 7:16 pm
What a sad day.
Comment by JustIce — 11/7/2009 @ 7:58 pm
220 yea votes.
Now to the Senate.
Comment by michael reynolds — 11/7/2009 @ 10:15 pm
Yay! The night conservatism died! So long boys! good night rushbo!
Comment by haha — 11/8/2009 @ 1:45 am
Pwnage.
Comment by Richard bottoms — 11/8/2009 @ 3:15 am
My longtime companion is an RN/CCN/LNC who divides her time between ERs and ICUs. She and I would like to extend a personal invitation to Rick, TMLutas and their ilk to join her for a 12-hour shift (usually with no breaks) in each of these units so they can see first hand the consequences of the peculiar American form of liberty that allows 40-some million Americans to go without health insurance, many millions more to struggle with inadequate insurance and millions more who lose their insurance because they have pre-existing conditions (like wombs, if you happen to be a woman).
It would take a liberty-loving conservative with the hardest of hearts to not question their lock-step opposition to health-care reform after 12 hours in an ER and another 12 in an ICU.
Lemme know when you want to set this up. Just make sure you bring your own snacks.
40-some million Americans to go without health
insurance, many millions more to struggle with inadequate insurance and millions
more who lose their insurance because they have pre-existing conditions (like
wombs, if you happen to be a woman).
It is childish to believe this situation is going to get any better under National Health Care. All we are doing is substituting one set of problems for another - while some of the same problems will remain and get worse.
Childish, naive, self deluding - to believe this “reform” will create some kind of health care paradise where all problems are solved and nobody suffers as you seem to believe is madness. Your companion’s life will not get any easier nor will those she is caring for suffer any less. You and many liberals have already imbued the reform efforts with supernatural ability to “solve” our health care problems. When it fails to measure up to 1/10 of your expectations, will you be able to summon the intellectual honesty to work to reform it? Or will you simply keep spinning?
ed.
Comment by Shaun Mullen — 11/8/2009 @ 7:30 am
“Childish, naive, self deluding - to believe this ‘reform’ will create some kind of health care paradise where all problems are solved and nobody suffers as you seem to believe is madness.”
Jesus Christ riding a pogo stick, what is it about Conservatives nowadays that only allows them to think in absolutes?
NOBODY advocating for health care reform claims it will make all of the problems of the world go away. The commenter never claimed that Rick, and you know it.
It WILL, however, help fix the problem of tens of millions of people unable to afford health care that they need. Pay very close attention Rick . . . I said “help fix”, not “completely wipe out without any consequences”. Will all Americans have all the healthcare that they need? Of course not. Will more have access to more? HELL YES. You focus on childish claims? How about “if its not an absolutely perfect solution than it is without merit”? Now that’s childish.
Of course there will be costs. Everything has costs. TANSTAAFL is just as inviolate a natural law as the law of gravity. But this problem isn’t going to get fixed with tax cuts, or allowing insurance monopolies to sell across state lines.
Comment by busboy33 — 11/8/2009 @ 8:51 am