Tuesday, December 29, 2009

The healthcare battle nears conclusion, but who are the winners?

by Cylinsier

The highest hurdles have been cleared. Both houses of Congress have passed their mangled, well-intentioned versions of health reform, each resembling a good plan in some ways and yet each bearing the scars of political machinations. The final step is cobbling the two together into something both houses will agree on, and then sending it on to the President for it to become official.

There are a lot of people, on both sides of the aisle, calling for this thing to be totally dismantled. They want a fresh start, and I don't totally disagree with them. There is enough in these bills to dislike that I too would like to take it back to the drawing board, but that is unrealistic at this point. One way or the other, there seems to be little if any chance that the Democratic majorities will remain the same in either house of Congress after next year's elections. Considering the paper thin margins by which each bill passed, and the nauseatingly partisan politics employed by the right and conservative left in attempting to stonewall this bill, there is no second chance. If this bill is tossed, then we have to be okay with that being all she wrote on this issue until the system collapses, because nothing is going to be done about it sooner.

There are also a lot of good reasons to see this bill passed. Admittedly, some are going to be of the petty nature; I can't be the only one that allows himself a bit of satisfaction in thinking about how hard the right has fought on their platform of lies and deceit, only to still see a bill passed (wishful thinking in many ways; the GOP is most likely secretly patting themselves on the back for doing so good a job of neutering the bill). But at the end of the day, whether or not this bill is signed and passed should depend on whether or not it improves the system in any way for the people of this country. Nothing else should play into it.

To determine whether or not the bill is an improvement, we need to understand it. It is my opinion that the final product is going to be most similar to the Senate version, as the House is already signaling making concessions to favor it. So what does the Senate version look like? According to Reuters, the bill includes:

  • a mandate for US citizens to purchase health insurance.
  • Federal subsidies for individuals up to 400 percent of the federal poverty line.
  • Federal tax benefits for small businesses.
  • Penalties for employers who do not provide plans to employees when said employees tap into subsidies to purchase coverage.
  • the creation of State-based insurance exchanges.
  • contracting between OPM (which overseas federal insurance plans) and private insurers to create non-profit plans available in the exchanges.
  • a medicaid increase in all states who's Senator didn't play mercenary with their vote.
  • the removal of the preexisting conditions copout.
  • the removal of higher charges based on gender, health history or employment.
  • the removal of insurers' ability to drop people when they get sick.
  • the removal of lifetime limits on coverage.
  • requiring insurers to cover preventative care.
  • a provision to streamline paperwork as well as other measures to reduce overhead costs.

Really, the House version isn't terribly different in most ways; its just some of the numbers that differ. The big difference is the public option, which existed in the House version, but which seems dead now. There was also a medicare increase floating around, but Senator Lieberman killed that.

So why are the above things good? Well, the mandate may not make people jump for joy, but its important to understand why that is included before being critical of it. If you remove insurers' ability to deny coverage because of preexisting conditions (and you should), but do not mandate insurance, then you will have a huge number of people who don't buy insurance until right after they get sick, then get a policy quick to cover costs, then cancel. The system can support that kind of use for approximately 3 seconds before succumbing. The mandate is probably the least popular part of the bill excluding debates of cost, but it has to be there or the whole thing falls apart.

The rest should be pretty straightforward unless you're a total asshole. There's nothing there that you can argue doesn't benefit a large number of people. So let's draw the line in the sand right here and make it crystal clear: the people that are against this bill have one argument, and that is cost. Sure, these are all good things, but how much of my paycheck do I have to fork over for it? Well, I don't think we're truly going to know that until the deal is done. Note that most of the above benefits don't kick in until 2014, so we'll sure have plenty more time to talk about it. But to say whether or not the cost outweighs the benefits, we're just going to have to wait and see.

I can tell you that the cost would have been nil, or even negative, if some people had just stopped bitching early on and let us have a public option or single payer, but there was too much money in politicians' back pockets and too much propaganda on Fox News for that to happen. Really, if we get boned by this bill, we have no one to blame but ourselves; for being gullible, for not putting the right people in office, and for succumbing to our own arrogance and selfishness. In a way, this bill failing might be a good thing for us. Americans seem to have a hard time learning by any means but the hard way nowadays.

But the reason I think this bill needs to be passed is twofold: first, I do firmly believe that more people will benefit from this bill than people will suffer from costs. I'm not saying there won't be a few people that see prices go up without a change in quality of coverage. Actually, most people will probably see no change at all. But the people that see their quality of life improve because of this bill will outweigh, probably by far, the people that see any kind of degradation. That's enough reason to support it for me. It seems everyone in support of this bill and reform in general also views the issue that way, while everyone against it seems to think only of how it will affect them personally. Morally condescending comments about being selfish pricks aside, the world and specifically this country does not run on the whims of a select few, regardless of how much money you have or your class status. The needs of the many outweigh that of the few. That's not an argument on what philosophy everyone should subscribe to, that's a law of nature.

The second reason I support this bill's passage is because I firmly believe that the people of this country, when it comes down to brass tacks, have just enough collective intelligence to recognize that any shortcomings of this bill are a result of it not going far enough as opposed to too far. If we start talking about making changes to this bill in a few years, it will be a move towards single payer, not away. I believe that because that is how things have always worked in this country. Just look at Civil Rights. It didn't happen overnight. There were baby steps, in some cases frustratingly and dishearteningly slow steps, towards something that actually worked the way it was supposed to. We might have had a shot at changing this overnight, but we missed it. That's not a reason to stand still for another decade or so. We need to take the first step to complete the journey. Comprehensive reform is still a ways off, but if this bill passes, it'll be just a bit closer.

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Gertrude said...

Mental health coverage is an issue that should get a little attention. Currently the law is that IF a plan covers mental health AND more than 50 people, then mental health coverage has to be the same as physical health coverage (the same copays, number of visits, etc). We need a recognition that mental health is inseparable from physical health and a mandate that insurance providers cover it. Perhaps we could allow only providers who cover mental health into the exchanges?

Ondinita said...

I wholeheartedly agree with you, Cy! But I think you're giving the majority of people too much credit! ;-)