Monday, March 22, 2010

Health Care: Last in a Series?

So, it's finished--all but the Epilogue, the Senate's passage of the reconciliation package. The Republicans may be able to delay it briefly, but the budget reconciliation procedures themselves should ensure that is not too long. The only hiccup that is likely is that if some provision in the carefully-vetted package does not fit within the limitations of budget reconciliation (as judged by the Senate's Parliamentarian), then there may need to be some minor modifications which would require it to return to the House again.

For that reason, Senate Majority Leader Harry Reid's work on the project is still officially Incomplete, but he seems headed for a B or B-. It was, after all, the Senate bill which was signed today, one for which Reid somehow managed to get 60 votes. It is a shame, though, that the Senate never had a vote on a public option--regardless of whether he had the votes, he let us down on that one.

President Obama also let them off on that topic--a government-run program was part of his original campaign promise (and no government mandate, either). This ended up being a success for him, a credit to his patience, persistence, and the power of his final pushes--for passage of the Senate's bill in the House, and framing the final reconciliation package, a delicate set of compromises and policy considerations. As he said about his first-year performance, "a solid B+".

Top marks (an A) go to Speaker Nancy Pelosi and the Democratic members of the House (the ones who voted for it, anyway). She and her team of Democratic leaders found the necessary formulas to deliver the votes that were needed, when they were needed, every time. She got a bill passed with a public option, too!

Republican efforts get a failing grade--their ideas were weak and insufficient, their tactics ugly and ultimately unsuccessful.

A Personal Note, and A Glimmer of Hope
In the five years since my COBRA policy ended, I've been one of those who've seen the ugly, blunt edge of our health insurance system. I have paid for 100% increase in monthly premiums (and in deductibles) on our Blue Cross policy, and a member of my family was denied coverage for a minor (but potentially expensive), pre-existing condition. Her insurance coverage (until--coincidentally?--this month) has been flimsy, overpriced, and continuously increasing.

This experience has taught me that the current system of private health insurance really is not a working one--I would not wish that experience on others, but if more had been exposed to it, they would not have been so complacent about the need to change this system. The private insurers do not deserve the additional business, and the continuation of their monopolistic control of most of the market, that this bill will further cement into place.

The effort to start a government-run program was an attempt to make the insurers honest. Instead, it will be attempted through regulation, and we shall see if this works, and for how long: there is a long history in this country of regulatory agencies being effectively captured and ultimately controlled by the industry they are supposed to regulate.

But wait--perhaps there is something with potential in this area in the bill, after all. Read this description in the excellent interactive chart summarizing key areas of the Senate bill and modifications included in the reconciliation package, from in Sunday's NY Times:
The federal Office of Personnel Management, which provides health benefits to federal employees, would sign contracts with insurers to offer at least two national health plans to individuals, families and small businesses. The new plans would be separate from the program for federal employees, and premiums would be calculated separately. At least one of the plans would have to operate on a nonprofit basis.

This text is far from clear: two pilot programs, but where and for whom? I did some research--the provision is in Sec. 1334. It will follow the Federal employees' health plan in design and implementation, though it will be separate from that very successful program. The government's Office of Personnel Management will take some time--months to a year?--to get proposals from insurers (or groups of insurers) and make contracts for this offering, which will initially be offered--to individuals, and small businesses--to 60% of states, and roll out to all within three years afterward.

This does suggest that maybe, in a few years, there will be something better on offer, something to complete "health insurance reform" (as President Obama correctly described it). Then, we can move on to the next, even larger task: that of reforming our health care system itself, how it works, and how it is paid for, so that we can deal with the tsunami wave of future health care needs that is visible on the horizon. Other than just heading for the hills!

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