I must confess that the more I read of the health care reform bill that just passed the senate this morning, the more it grows on me.
Unfortunately, that growth is a cancerous tumor, one that will be impossible to excise once this God-awful monstrosity becomes law.
If the Democrats had stuck to their original intent - covering more people, covering those who are chronically ill and denied insurance, and trying to bend the cost curve on Medicare - I would probably have supported it. These things are necessary goals for America and legislation was desperately needed to address these problems.
But the overreach in this bill is incredible. Non-partisan outfits like CMS are saying that premiums will go up drastically, that the bill won’t do anything to reduce the cost of health care, that the quality of care will go down, and that even cuts in Medicare payments to doctors and hospitals (if they could be sustained which they haven’t been over the last 9 years) won’t have any effect on the cost curve.
As far as coverage, that same CMS report figures a net increase of 3 million Americans who will be insured - 12 million will lose their insurance through their employer while 15 million will gain insurance coverage that way. This doesn’t include the estimated 15 million who will now be eligible for Medicaid - an unfunded mandate (except for Nelson’s Nebraska and Landrieu’s Louisiana) that will top $60 billion according to some estimates. Increased state taxes to pay for new Medicaid coverage is not included in the cost of the bill.
The bill is profligate with the taxpayer’s money when it should have been niggardly. It places the heaviest hand imaginable upon health care consumers instead of the lightest touch possible. It’s strictures, rules, and regulations on insurers guarantee higher premiums. And it will take unfairly from the young and give to the old by forcing the “young invincibles” to purchase coverage they will probably not need in order to service seniors.
Seniors have their own problems with this bill - some of it ginned up outrage over nothing - but many of their concerns are well heeded. The destruction of supplemental insurance programs by cutting back on what they can cover, as well as increasing their costs will mean more out of pocket cash spent on health care by Medicare patients. This is the goal, of course; to discourage people from using the health care system. And the Medicare cost containment panel frightens many seniors with its mandate to discover the efficacy of specific treatments for specific diseases and conditions. Hardly a “death panel” - more like Obama’s “take an aspirin for the pain” panel.
If some of this would have accomplished some of the goals the Democrats set out to fulfill, there’s a chance that reasonable conservatives could have supported it. After all, no bill is going to be perfect, and the opposition, working with the material you have at hand in order to improve it, might have achieved at least the appearance of bi-partisanship.
It’s not the the Democrats were necessarily not interested in bi-partisanship as it was they were not interested in the gradualist approach favored by those few lawmakers in the GOP who would have supported health care reform. When even Olympia Snowe and Susan Collins wouldn’t get on board, this should have been a sign that what the Democrats were proposing was a bridge too far even for moderate Republicans.
Married to process rather than sticking to substance, Harry Reid then took a bad bill and made it infinitely worse by trying to please all segments of his caucus. The buy offs, the favors - all the little ornaments Reid added to this Christmas tree of a bill made it less fair, more complex, and more expensive.
Previously occupying the “Worst Piece of Legislation” niche in my mind was the 1981 tax cut bill - a bill that guaranteed huge deficits as far down the road as anyone could see by allowing every Congressman, every special interest group - even individual companies - to get a tax cut goodie written into law. If the coalition of Republicans and conservative Democrats had stuck to the original intent of across the board tax cuts and a few business goodies like cutting the capital gains tax, the bill would have cost a third of what it eventually cost. Of course, the bill did jump start the economy, but at the cost of massive deficits that weren’t reined in until Clinton’s presidency a decade later. It should go without saying that the Republicans under Bush abandoned any pretense of fiscal responsibility and ran up record deficits - at least they were a record until this crew got into office.
And now, we’re looking at another “crapshoot” as one Democratic congressman referred to the tax cut bill nearly 30 years ago. (The GOP sage Howard Baker called it a “riverboat gamble.) Nobody can possibly know what the outcomes will be from playing with such a large chunk of the American economy. How much more will the bill cost than advertised? The CBO thinks $1.5 trillion while others see that figure doubled. What will be the effect of people being forced to buy insurance? Will enough of them buy into the system to help slow the rise in premiums (forget the idea they would come down - that’s baloney)?
How will all these changes in Medicare play out in the real world? How many people will take advantage of the increased eligibility (133% of the poverty level) for Medicaid? How will states pay for that increase? How will the exchanges work? What will happen to private insurance carriers who now must cover those with pre-existing conditions? How many companies will opt-out and pay the fine rather than cover their employees? What will happen to small businesses who will see their cost of doing business skyrocket, despite “tax credits” to assist them? What will be the effect of the cost control panel on the quality of care?
I could fill a page or two with questions about the future of health care in America. But the only question that matters is, with so many unknowns, what possessed supposedly sober, prudent lawmakers to pass this bill in the first place?