Monday 28 December 2009
There are widespread opinions out there on the Senate version of health care reform. I understand people's frustration with how "Traitor Joe" Lieberman and "Ben Arnold" Nelson held the Senate bill hostage. A robust public option would have been a great start to the real reforms needed to fix our broken health care system. Traitor Joe and Ben Arnold succeeded; there will not be a robust public option.
Many progressive groups have not given up on getting a public option this time around. Putting energy into pressuring Congress to come out of conference with the public option restored is a waste of valuable resources. One group goes as far as calling for the Democrats to call Lieberman's bluff and force him to filibuster the old-fashioned way by holding the floor for days. The problem with that is the need for 60 votes in the Senate has not gone away with the Christmas Eve passage of the Senate bill.
When the House and the Senate complete their next task and merge the two bills, the final version will go back to the Senate and the House for a final vote. While it is true that there can be no amendments and the final bill is not subject to debate, it is subject to one more cloture motion in the Senate. If the Senate doesn't reach 60 votes on that motion, they can't vote on final passage.
With the need for 60 votes in the Senate, the reality is the final bill coming out of conference will look a lot like the bill that passed the Senate. If the House version of the public option comes out of conference, I believe Traitor Joe and his 40 GOP Republican colleagues would kill the bill.
I know many groups are telling people that after conference there is only a need for 51 votes. They are wrong; I thought the same thing in August only to have many Congressional sources tell me I was wrong. Over the last few days, I confirmed the continued need for 60 votes with Senator Reid's office as well as Senators Levin and Feingold.
Many are saying it's better to just let the bill die and start over. I disagree, and here is why.
Access to the Same Options as Members of Congress
Does everyone remember cheering when many Democratic Party candidates for president called for allowing the American people to buy into the same insurance plans as members of Congress? Bill Bradley was the first; I seem to remember Howard Dean, John Edwards and John Kerry proposing the same thing. I know that it was in most of President Obama's stump speeches last year. It's in the Senate bill - well, not exactly.
Remember the confusion when most were reporting the public option was dead and Harry Reid unsuccessfully tried to deny that, saying there was still a public option in the bill? He wasn't referring to the Medicare expansion; he was referring to the compromise on the public option. It wouldn't be a total public option; private insurers, at least one of which would be a nonprofit, would offer national plans that would be administered by the same government agency that administers the federal employee health plan. That is what members of Congress have, so it is what President Obama and many past Democratic Party candidates campaigned on for the last decade.
It is not as good as the public option in the House bill, but it is better than what we have today.
- It will be illegal to deny people based on pre-existing conditions; that, in itself, is a major reform.
- There will a cap on out-of-pocket expenses.
- Small businesses will be able to buy from a national exchange, giving them increased buying power.
- A new benefit will allow workers to buy into a plan that will provide them a cash benefit if they become disabled and need in-home care.
- Access to Medicaid will be increased to people making 130 percent to 150 percent of the poverty level; the percentage will be worked out in conference.
- There will be limits on insurance company profits, requiring that 85 percent of revenues be spent on delivering health care.
- If insurance companies exceed those limits and more than 15 percent go to advertising, profit etc., they would have to pay rebates to those they insure.
- The Senate bill requires all insurers to fully cover federally recommended preventive health services, such as immunizations, colonoscopies and HIV testing.
- Insurers would not be allowed to rescind a policy for someone who gets sick.
- State and federal regulators would be required to review rate increases and determine if they are justified.
Let's face it, if this bill was the first offer and we were not teased by the "robust public option," we would all be ecstatic.
Reform Doesn't End With the President's Signature
FDR has a legacy as a great reformer, but let's not forget that Social Security was weakened to get it through Congress, and then reformed over the years to make it a better program.
Advocates for universal health care need to continue to fight until every American has full health care coverage. There are short-term fights that can be waged right away: How about eliminating the three-year exemption on pre-existing conditions? Let's make it an election-year issue to make the law outlawing denial of coverage based on pre-existing conditions go into effect immediately instead of in 2014. Expanding access to Medicare to younger Americans would be a powerful election-year tool; let's make Republicans come out on the record against that without the ability to hide behind other parts of a larger bill.
I understand everyone's frustration, but let's get strategic and accept this as a first-round win, and continue to fight until the American people get what we deserve: universal health care delivering as good an outcome at as good a cost as other industrialized countries. Until someone proves me wrong, I believe that means single payer.