Monday, December 14, 2009

Health Care Update

The latest outrage is the report this evening that the Senate Democratic leaders are abandoning the hard-won agreement made by the Group of 10 (five Blue Dogs, five liberals) in order to get the bill's debate ended.

The particulars are as follows: Sen. Lieberman, who was dropped from the group's deliberations after he failed to attend its meetings consistently, informed the leadership that he would not vote for cloture on the bill if it included the provision to expand Medicare to (some) people between the ages of 55 and 64, nor if it had a public option. This was a serious betrayal by Lieberman, actually of a position (the expansion of Medicare) that he has supported consistently in the past. He deserves richly all the condemnation he is going to receive for this backstabbing flip-flop.

It's not that there couldn't be doubt about the wisdom of expanding Medicare, although the proposed expansion may have been relatively modest in terms of people who would actually have been able to take advantage of it (it's hard to be sure about that, as the details of the agreement were never revealed). Medicare is a good health program, but it is chronically underfunded and unpopular with some health care providers because of the lower rates of payment for services.

What Lieberman's phonily principled stance provides, though, is a blatant sellout to the private insurers, who want the expansion of coverage to be given them--through mandates for all to have health insurance--with the least strings attached and the least competition possible from outfits not working off the profit motive. The reason why Medicare expansion is not acceptable to certain Senators is the reason why the public option can not be tolerated by them.

It is clear now that the Senate bill will have the form of whatever can get all 60 votes of the 58 Democrats, plus Lieberman and Bernie Sanders, whose vote might now need some serious coaxing, as well, on the other side. It is possible, though, that this latest set of retreats may be enough to gain one big Republican vote, that of Sen. Olympia Snowe.

It almost doesn't matter what the Senate bill has in it, because the bill will need some serious reconciliation in the conference committee with the House's bill. The House will have just as much say in the product to be returned to both houses for final approval as the Senate, and we should expect the House conferees to be tough about letting go of the public option. One thing that won't be in the conference committee's report now, though, is this expansion of Medicare.

I'm hoping Sen. Harry Reid has a parliamentary trick up his sleeve to get a conference committee report approved that will be quite different from what the Senate is going to approve. This Senate bill will not achieve what it aims to do, because the uninsured are not going to be signing up for the bad deal offered privately outside of group employer insurance, mandate or no.

I repeat my statement to the DSCC (the fundraising committee for the Democratic Senate campaign) that accompanied my final contribution to it earlier this year:
1) If there is no vote in the Senate on the public option, I will give no money for the 2010 campaign to Democrats;
2) If the public option is included in a bill the Senate approves, I will give as usual;
3) If it is voted upon, and not approved, I will not give to general funds for Senate Democrats, but will give selectively.

Anyway, I see no urgency to contribute to Senate Democrats, in general: there is no way Democrats can "lose control" of the Senate (if you call this having control). The Republicans have just as many tough races as the Democrats in 2010: I would say, even with a poor economic environment, that the range of results goes from -3 to +3 for the Democrats and their current 59 votes (after Lieberman is booted from the caucus and his committee chairmanship, which should happen quietly early next year).

I'm ready to declare war on Lieberman, who has clearly been bought and paid for by the private insurers (who are, of course, big employers in Connecticut). It's too bad he will probably never run again for public office after this betrayal.

Baby, You Can Drive My Car
From the above discussion, it is abundantly clear that this healthcare bill has nothing to do with providing choice for the public. I am not so sure, even in its most malevolent, ill-considered form, such as with the House's "Stupak" Amendment, that it will do much directly to affect the right of women to choose an abortion (to the extent they already have it).

First of all, Stupak (a Democratic Representative from Michigan) himself denies it. He has gone on record that his objective is merely to maintain the status quo, which since the so-called "Hyde amendment" for some 20 years has been that no Federal funds may be used to pay for abortions. The danger foreseen by abortion opponents is that subsidies helping to pay for poorer people's health insurance in this legislation will include coverage for abortions.

I will say very clearly that this amendment is very bad design for public policy: poor people are exactly the ones who need to have contraception--and abortions, if necessary--in their health insurance. Taking this feature out of their policies will be one more reason they will not take up the ripoff policies that would be foisted coercively upon them in upcoming years by this legislation.

Nevertheless, I feel confident that private health insurers can come up with a practical and profitable solution to this problem. The answer is an inexpensive, optional rider to basic health insurance plans which I would call "contraception insurance".

The way it should work is as follows: sexually active women of childbearing age should have access to a plan, which should cost about the same monthly as the retail price of birth control pills. The coverage would provide the insured with birth control (which was purchased for their clients' use wholesale), any necessary consultation with a doctor for them to choose the appropriate method, and coverage against "accidents"--which all methods of birth control are subject to--as well as any medical side-effects. Now that the "morning after pill" has finally been approved by the FDA, that would be the normal (covered) recourse for failures of contraception, but abortions would be covered, as well, for those who couldn't "nip it in the bud".

I don't see a big problem here--it's almost comparable to auto insurance, which is competitively priced and provides the necessary coverage. Yes, those who have repeated "accidents", or refuse to avoid unsafe behavior, might eventually have to be dropped from coverage.

The real threat to accessibility to abortions in America is the scarcity of those who perform them in large sections of our country, and this bill isn't going to do anything about that in any case.

No comments: