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We’re Not Done Yet

December 25th, 2009, 03:12 am admin Leave a comment Go to comments

Like DemFromCT, there are things in this bill that I think should be celebrated. It’s historic in the sense that this is the first time both chambers of Congress have passed a bill that tells insurance companies that they can’t operate with impunity any more. That is farther than we’ve gone before.

Bernie Sanders’ expansion of Community Health Centers is a vital component to actuallly extending affordable health care to signficant numbers of people across the country. The Medicaid expansion similarly will actually help extend actual care. And the high risk pool created immediately, though seriously underfunded in the Senate plan, will be an immediate good for some of the people who most need it.

But, actual health care reform was a tall order, one that this bill doesn’t necessarily meet. So while historic, it’s only so because the bar was set so damned low. Thus, tempering victory statements should be in order for a variety of reasons. First and foremost is that insurance reform is not systemic healthcare reform, and selling it as such is a recipe for potential political disaster.

There are going to be tremendous frustrations when this is implemented. It’s a Rube Goldberg contraption of a thing, and will be glitchy to set up and get going, no doubt about it. That will be compounded if the Senate prevails on the set-up of the exchanges and the states are setting up two separate exchanges–the regular one and the small business one. A single, national exchange makes oodles more sense, and could ease what is already going to be a complicated, frustrating business.

If the implementation date for some of these provisions isn’t moved up, there’s the potential for tremendous dissatisfaction–most of the public is not as tuned into the debate as we are, and now that something has passed, they’re going to expect things to be fixed, particularly when they hear statements like:

“If passed, this will be the most important piece of social legislation since the Social Security Act passed in the 1930s, and the most important reform of our health care system since Medicare passed in the 1960s.”

They are still going to have paperwork, and lots of it. They are still going to have to send a good chunk of their paycheck to their insurer, and if you can take AHIP’s word for it, potentially even more of it, since the insurers will still be able to raise premiums essentially at will. The prohibitions on insurance company abuses will only be as effective as the state insurance commissioners now slated to enforce them, and insurers will test those limits.

But there’s also a policy danger in overselling this bill, and that’s primarily in setting such a low bar for the would-be reformers for what actually constitutes reform. First and foremost, insurance is not care, particularly when middle-class people could be spending as much as 22% of their income on health care costs. Yes, that’s more affordable than the status quo, but more affordable than what we have now is not the same thing as actually affordable.

Perhaps recognizing this, Reid’s statement this morning was somewhat tempered:

“This morning isn’t the end of the process, it’s merely the beginning. We’ll continue to build on this success to improve our health system even more,” Reid said before the vote. “But that process cannot begin unless we start today … there may not be a next time.”

The good news for Reid is that next time is conference, if he’ll start holding some ConservaDem feet to the fire. Nelson and Lieberman had their chance in the Senate to put their stamp on the bill. Now that they’ve done so, Reid and Obama both need to twist their arms on the conference. The best way of making this effort build toward real reform is with the affordability, accountability, and competition the House bill provides.

The Senate bill doesn’t have to be the final bill, as much as everyone would like just to be able to say we’re done. There’s improvements to be made, and they’re already in the House bill, which provides more generous coverage levels and isn’t built on the exceedingly regressive Chevy health plan tax. It also provides the additional check on insurance company behavior of real competition in the form of a public option.

So huzzah to the Senate for finally pushing this through. Take a break and enjoy your holiday. But by no stretch of the imagination consider reform accomplished, and get ready to do some real good when you get back.


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