Not perfect, but for health care a major advance
Tuesday, December 22, 2009
WASHINGTON — When all is said and done — and, yes, there is a bit more saying and doing to endure, which means that anything can happen — the health care reform legislation that President Obama now seems likely to sign into law, while an unlovely mess, will be remembered as a landmark accomplishment.
The bill making its way through the Senate by the slimmest of margins is imperfect, to say the least. But before listing its many flaws, let’s consider the measure’s one great virtue: For the first time, we will enshrine the principle that all Americans deserve access to medical care regardless of their ability to pay. No longer will it be the policy and practice of our nation to ration health according to wealth.
When you blow away all the smoke, that’s what this fight is about. The Senate bill lacks a public health insurance option, the House bill is burdened by gratuitous abortion restrictions, and the final product of a House-Senate conference will probably have both those failings. But once the idea of universal health care is signed into law, it will be all but impossible to erase. Over time, that idea will be made into reality.
The loose ends are so many and varied, in fact, that it will probably be necessary to revisit the health care issue sooner rather than later. Even if it takes years to get it right, eventually is better than never. History suggests that major new social initiatives have to be perfected over time — and that basic entitlements, once established, are rarely taken away.
Progressives who argue for killing the Senate bill and starting over should explain their position to the 30 million Americans without health insurance who would be covered under this insufficiently progressive legislation. They should recall that when Obama and the Democratic leadership in Congress began this crusade, public opinion was solidly in favor of reform. With polls now showing widespread wariness, with Republicans having confused and frightened many voters who already have adequate health insurance, why would anyone think that beginning from scratch is likely to produce a more progressive result?
It surely wouldn’t. For anyone who believes it is shameful that the richest, most powerful nation in the world cares so little about the health and welfare of its citizens, this is the moment. It should be seized, not squandered.
Is it ridiculous that the Senate bill essentially bribes Sen. Ben Nelson with special Medicaid reimbursements for Nebraska alone? Yes. Is it galling that the public option and the idea of a Medicare buy-in fell victim to Sen. Joe Lieberman’s whims? Supremely so. But our eyes should be kept on the prize.
The bill has been described as a gift to the health insurance companies since it provides them with 30 million new customers and no competition from a public plan. I don’t believe it’s a coincidence that the stock prices of health insurers are soaring. But I also don’t believe the main point of this exercise was to stick it to the insurance companies, however satisfying that might be.
Someday, perhaps, we will deal with the perversity of having for-profit health insurance companies. Executives of those firms have a duty to maximize value for shareholders, which gives them the incentive to behave badly — rejecting those who are most in need of health care, denying reasonable claims, raising premiums whenever possible. If health care is a fundamental right and a societal good, then why should its allocation be mediated by the private sector? But this is not the debate we’ve just had.
Eventually, we probably will ask that question. While the reform package nearing completion bends the curve of rising health care costs, more bending is going to be needed. Ultimately, we’re going to have to take a more fundamental look at how the health industry is structured.
So this isn’t the end of a process that leads to a rational, sustainable, more efficient health care system. It’s the beginning. But when a reform bill passes, as now seems likely, Obama and congressional leaders will have achieved a goal that progressives have sought for decades. They will have established that quality health care should be for all, not just for those who can afford it.
We have a system now in which Americans go bankrupt trying to pay doctors and hospitals to keep them alive. When you have the opportunity to change this, you take it — even if it means winning ugly.
Eugene Robinson’s e-mail address is eugenerobinson@washpost.com.
Comments
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Norm (Norm Messer) says...
"But I also don’t believe the main point of this exercise was to stick it to the insurance companies, however satisfying that might be"
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Insurance companies are the cause of the major problems in our health care system. Any deal that fails to "stick it to them", or even worse, showers more corporate welfare on them, is not reform; it is making the existing problems worse.
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"But this is not the debate we’ve just had."
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True. We have not had an honest, substantive debate about defining and remedying the problems in our system. That's why nothing positive has been accomplished.
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"Obama and congressional leaders will have achieved a goal that progressives have sought for decades. They will have established that quality health care should be for all, not just for those who can afford it"
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No. They have merely provided rich corporations with another excuse through which to extort money from the poor and welfare from the taxpayers without giving any value in return. This is not and has never been a goal of progressives.
December 22, 2009 at 8:06 p.m. ( permalink | suggest removal )
mavulous (mav ulous) says...
>Insurance companies are the cause of the major problems in our health care system.<
No they aren't! Well, yes and no. They are to blame inasmuch as they are bound to cover rising healthcare costs by virtue of their contract with the insured. That means that they continue to cover rising costs and must raise premiums to stay solvent. If insurance companies just went away completely, then medical costs would drop like a rock because few could afford to pay for the costs out of pocket, thus forcing prices through the floor and not the roof. The downside with that is it would take away the profit incentive to discover new and better treatments for a variety of maladies.
The problem really isn't with the insurance companies per se. Rather, the problem lies with the fact that health care costs continue to skyrocket for a variety of reasons:
http://www.youtube.com/watch?v=JYC2DJ...
December 22, 2009 at 8:22 p.m. ( permalink | suggest removal )
mavulous (mav ulous) says...
>When you blow away all the smoke, that’s what this fight is about. The Senate bill lacks a public health insurance option, the House bill is burdened by gratuitous abortion restrictions, and the final product of a House-Senate conference will probably have both those failings. But once the idea of universal health care is signed into law, it will be all but impossible to erase. Over time, that idea will be made into reality.<
This is probably true--at least to the degree that Social Security has been successful. The final health care bill that Obama will eventually sign will be a start, a foundation upon which to build another bureaucratic monstrosity that the people will eventually come to accept and maybe even like--at least to some degree, similar to Social Security. However, without a single payer system, without a public insurance option, and without an early buy-in for those 55 and older, this bill was well gutted. Fact is, Dems made concession after concession until very little substance was left in the bill. Obama wanted this one so badly for his legacy that he settled for little of nothing just so he and his administration could apply lipstick to this ham in the hope that everyone would buy it for Christmas. Few will--BUT--it's a start and Obama and the Dems now own it. The only question unanswered is how many seats will the Dems lose in the next election? After all, recent polls indicate that only 40% of the country supported this legislation.
December 22, 2009 at 8:45 p.m. ( permalink | suggest removal )
Norm (Norm Messer) says...
"The final health care bill that Obama will eventually sign will be a start, a foundation upon which to build another bureaucratic monstrosity that the people will eventually come to accept and maybe even like--at least to some degree, similar to Social Security"
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A better analogy than Social Security or Medicare is the military-industrial complex, since the main feature of the Senate bill is massive public subsidy of the private insurance cartel.
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" However, without a single payer system, without a public insurance option, and without an early buy-in for those 55 and older, this bill was well gutted. Fact is, Dems made concession after concession until very little substance was left in the bill."
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You're making too much sense, here, mav. Are you feeling ok?
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"Obama wanted this one so badly for his legacy that he settled for little of nothing just so he and his administration could apply lipstick to this ham in the hope that everyone would buy it for Christmas"
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"The president wants to pass a health care bill so bad that he will literally sign anything. You can water it down however you like--as long as it's a stack of paper with the words 'health care' on it he'll sign it," an eager Biden said from the Oval Office while President Obama is abroad."
http://www.huffingtonpost.com/2009/11...
December 22, 2009 at 11:08 p.m. ( permalink | suggest removal )
Norm (Norm Messer) says...
From Harpers:
"The private insurance industry, as currently constituted, would collapse if the government allowed real competition. The companies offer no real value and so instead must create a regulatory system that virtually mandates their existence and will soon actually do so.
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A study by the McKinsey Global Institute found that health insurance cost the United States $145 billion in 2006, which was $91 billion more than what would be expected in a comparably wealthy country. This very large disparity may be explained by another study, by the American Medical Association, which shows that the vast majority of U.S. health-insurance markets are dominated by one or two health insurers...Meanwhile, there has been year-to-year growth in the largest health insurers’ profitability,” the AMA reports, even as “consumers have been facing higher premiums, deductibles, copayments and coinsurance, effectively reducing the scope of their coverage.” And yet no innovating entrepreneurs have emerged to compete with these profitable enterprises. The AMA suggests this is because various “regulatory requirements” provide “significant barriers to entry.” Chief among those barriers, it should be noted, is an actual congressional exemption from antitrust laws, in the form of the McCarran–Ferguson Act of 1945.
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Insurance companies aren’t quite buggy-whip manufacturers. But they are close. In the past, one could have made an argument that in their bureaucratic capacities—particularly, assessing risk and apportioning payments—insurance companies did offer some expertise that was worth paying for. But all of the trends in politics and in information technology are against insurance companies’ offering even that level of value. Insurance is an information business, and as technology makes information-management cheaper, technological barriers to entry will fall, and competition will increase. (People who relied on the cost of printing presses to maintain a monopoly should be able to relate.)"
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Read the whole story at: http://www.harpers.org/archive/2009/1...
December 23, 2009 at 7:11 a.m. ( permalink | suggest removal )
artmann (Art Mann) says...
Another joke...??? The Mckinsey Global Institute is a Liberal hodge podge of elitists. It is headed by Diana Farrell a Democrat contributor who believes in moving US jobs offshore (because we can re-educate and provide unemployment benefits to those displaced (does this solve the loss of a job??)) and thinks cars are dirty so she doesn't own one (no she's not a freak, either) .
Oh yeah, she is a member of Obama's National Economic Council and the American Trilateral Commission.
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Any surprises here...........
December 23, 2009 at 10:24 a.m. ( permalink | suggest removal )
artmann (Art Mann) says...
Oh, did I mention she worked for Goldman Sachs before McKinsey.....
The plot thickens if you Google and read about this woman and her Goldman/Obama relationships, new world order, globalization.......
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http://littlesis.org/person/37031/Dia...
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December 23, 2009 at 10:31 a.m. ( permalink | suggest removal )
Norm (Norm Messer) says...
What does any of that have to do with the health care bills under consideration, art?
December 23, 2009 at 10:37 a.m. ( permalink | suggest removal )
artmann (Art Mann) says...
You said this-
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A study by the McKinsey Global Institute found that health insurance cost the United States $145 billion in 2006, which was $91 billion more than what would be expected in a comparably wealthy country"
You see your source is a bunch of commies who are driving this country down a very stupid path.
December 23, 2009 at 10:57 a.m. ( permalink | suggest removal )
Norm (Norm Messer) says...
1. The article I linked to and the data from the McKinsey Global Institute are arguing against the Senate bill and specifically against the mandate requiring people to buy insurance. Are you certain that you oppose these things?
2. Whether or not an institution is truly a "liberal hodge-podge of elitists", says nothing about whether or not its data are accurate.
3. An unsourced conclusory statement by an anonymous internet poster isn't sufficient to establish whether or not an institution is a "hodge-podge of liberal elitists".
December 23, 2009 at 11:58 a.m. ( permalink | suggest removal )
artmann (Art Mann) says...
I am going by what a two minute read of googling the names you give said. I could also throw in anti-american, but that is a given since you used them as a source.
I am opposing any data this organization spews. It is about as reliable as anything that Obama says.
December 23, 2009 at 12:16 p.m. ( permalink | suggest removal )
Norm (Norm Messer) says...
So you support the Senate health care reform bill. Just to spite me. More impeccable logic, art.
December 23, 2009 at 12:20 p.m. ( permalink | suggest removal )
artmann (Art Mann) says...
No, this conclusion is impeccable logic, Norm.
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"So you support the Senate health care reform bill. Just to spite me"
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December 23, 2009 at 12:29 p.m. ( permalink | suggest removal )
artmann (Art Mann) says...
Oh oh....Houston we have a problem. Some are calling this Madoff accounting.
I wonder what kind of deal the CBO folks can get?!?!?!?
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http://www.washingtonexaminer.com/opi...
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December 23, 2009 at 1:03 p.m. ( permalink | suggest removal )
Norm (Norm Messer) says...
You really ought to follow your sources better, art. Your washington examiner article grossly misinterprets the CBO document it purports to be based on: (this CBO document: http://www.cbo.gov/ftpdocs/108xx/doc1...
released today (Dec 23).)
But don't take my word for it; go to the CBO website itself (here: http://www.cbo.gov/doc.cfm?index=10868 ), click the link to the previously referenced document and read it, then click the link to the next document, also dated Dec 23: http://www.cbo.gov/ftpdocs/108xx/doc1...
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Read the whole document; here's the relevant portion:
"Earlier today, CBO provided additional information about the projected effects of the Patient Protection and Affordable Care Act (PPACA), incorporating the manager’s amendment, on the federal budget balance and on the balance in the Hospital Insurance (HI) trust fund. CBO has been asked to elaborate on that information by providing specific estimates of the impact of the legislation, as amended, on the solvency of that trust fund.
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Under current law, and based on the economic forecast and technical assumptions in CBO’s March 2009 baseline, CBO projected that the HI trust fund will be exhausted—that is, the balance of the trust fund will decline to zero—during fiscal year 2017. Relative to that baseline, CBO estimates that enacting PPACA, including the manager’s amendment, would reduce net outlays for Part A (Hospital Insurance) of Medicare by $245 billion over the 2010-2019 period. CBO and the staff of the Joint Committee on Taxation estimate that enacting PPACA as amended would increase HI payroll tax receipts by about $113 billion over that period. Given those changes in the financial flows of the trust fund, CBO estimates that the HI trust fund would have a positive balance of about $170 billion at the end of fiscal year 2019. That balance would be declining, and would be exhausted within a few years. The amended bill would add about $50 billion more to the trust fund balance in 2019 than would the legislation as originally proposed, and thus would maintain a positive balance in the trust fund for a slightly longer time than the original version."
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Now let me be perfectly clear: I oppose the Senate bill, but my opposition is not based on faulty interpretations of data as in art's present article.
December 23, 2009 at 2:53 p.m. ( permalink | suggest removal )