Now that the Senate Finance Committee's Health Care Reform Bill is up for vote, all we can do is wait to find out what happens next, and do our best to wrap our head around what this all means - for the Democratic Congress, for the legitimacy of Obama's presidency, and oh yeah, health care in the United States. I feel as though until recently I've been somewhat narrow minded when thinking about health care reform, having lofty hopes and expectations of what positive changes will come from this proposed $830 billion plan, but I'm realizing that the weight in each congressional vote is so much more than just the issue at hand, it's about politics. Each vote cast for or against the proposed bill is just as much about the arms race for power in congress and breaking or building up the reputation and legitimacy of Obama's Administration. Republicans are fighting this bill with their ideological reasons (against individual mandate as a violation of human rights, for example) but they are few and far between, they're focused on a larger agenda: the undermining of Obama's presidency. If they stop Obama from passing a health care reform bill, they are planning to use it as his Waterloo, to break him and destroy his presidency. The Republican party is shrinking and is left with a group dominated by white male conservatives, bordering on radical, and lacking real leadership. And as you might have noticed, the gap in leadership has opened up the arena for outrageous right-wing media personalities such as Glenn Beck. They want their power back, and they're focusing on this health care bill to be their ticket to victory. Obama stepped up to the plate under daunting circumstances after Bush's presidency and has charged forward with a goal in mind. What we're seeing now as we wait for the Senate Finance Committee's bill to pass is that in an effort to make sure this bill passes at all costs, every major component of the bill is in a constant state of being watered down. A comprehensive successful pan must include proposed solutions to the following issues - access, cost containment, and quality. What we're likely to see pass is just the first part of this equation, access.
To satisfy constituents, Obama has made deals with nearly all of the major stakeholders involved in health care - insurance, pharma, hospitals. The deals were made early in the summer which already set limits to how radical the reform bill could be. Couple that with the extreme political pressure to get something (anything!) passed, and what we're left with is a watered down plan that will provide access to all citizens through and expansion of government programs, but not much more. Though some in congress are still fighting hard for a public plan, there's a very narrow chance anything of the sort will end up on the bill. Through tens of millions of dollars in lobbying by the insurance industry fearing that a public option will create too much competition and eventually drive them out of business, the public option idea has been essentially thrown to the wayside. I think it's a little extreme and quite frankly ridiculous to claim to say that adding a government run plan to market competition with drive insurers out of business. Public and private entities exist in many other industries that make up large portions of our gdp and I don't foresee the private sector going out of business any time soon. Let's take social security for example. Social security is the largest government program in the world and the single greatest federal expenditure, and it coexists with 401(k)'s in our open market. The financial industry providing 401(k)'s contribute billions of dollar's to the United State's GDP, while social security provides insurance gathered from payroll taxes on worker's wages (that distributed over $500 billion in 2004), and neither seem to be disappearing as a result of the others competition.
It's a shame that as a result of all the politics and lobbying, the public option is discounted even though it may be exactly what the country needs to be able to provide insurance coverage for the 47 million uninsured Americans. Even with the proposed expansion of Medicaid and government subsidies, it is projected that over 10+ million people will still be left uninsured after the reform bill passes. With the individual mandate for insurance in place, and insurance prices being decided based on solidarity principle, or membership of a group with shared costs across high risk and low risk participants, Americans are given the access to health care, but without and restrictions and regulations on how costs will be contained and what quality of care you're getting. Sure, you've got access to health care, but if you can't afford to buy insurance and there's no incentive to provide quality care, we're stuck in the mud. I would think creating a plan for providing better quality would be at the core of reform, then figuring out how to make high quality care affordable, then lastly making the affordable high quality care scalable to all Americans would be the logical process. Unfortunately, the political strong arming in congress and the lobbying influences can't be ignored, and the push for some sort of reform to pass to give a political win the Dems and Obama is the reason we're getting this reform bill that's short of what really needs to be in place to be sustainable and successful. There's nothing in the bill that addresses how costs will be contained to stop the steady rise of costs that we've been seeing over the last few decades.
To provide an example of how backward the plan is, there was a proposed public option "trigger," meaning after a set period of time if private insurance companies cannot meet certain success metrics for coverage (lower premiums, higher quality), a public plan would be triggered into place. In order to placate the private insurers, this idea was suggested as an alternative to including public option in the bill right now. Can't we determine if insurance companies aren't providing coverage based on metrics right now, at this current moment in time, rather than giving them time to "shape up"? I think most experts would argue that there is something seriously wrong with the way coverage is provided right now, which is why reform is necessary, so giving insurance companies more time to see what changes than can muster up seems counterintuitive. Put the public option on the reform bill now, and avoid wasting more years on a system that we already know is broken.
At the end of the day though, it all comes back to politics. It's nice to think that the reform proposed in the bill that eventually passes is 100% based on what's best for America in repairing health care, but unfortunately it's not the case. Republicans are doing everything they can to break Obama. Thinking of every other major bill that has gone through congress over the years, there have always been votes from both parties in the majority, but out of sheer political determination to undermine Obama in any way possible to show that he cannot pass a big policy bill, Republicans aren't focused on the content of the bill, they've got their eyes on a larger prize. It means Obama will be counting on every Democratic Senator and member of Congress to vote for reform, which is why the "Blue Dog Democrats" have been put in the spotlight. Ordinarily moderate to conservative Democrats weren't the biggest concern to earn the votes of but with the guarantee that not a single Republic will vote for the bill, they need to be able to count on every single vote available. But like I said, all we can go is sit and wait. Waiting for the vote can lead to head spinning discussions that lead to frustration and at times disappointment and anger, but there needs to be at least a glimmer of hope to keep us going and supporting the cause. The fight is tougher than some have been in the past (consider how easily bail out bills from Bush passed), it means much more than just health care reform, and I suppose we have to understand and respect that. After all, it is all politics.
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