Thursday, December 17, 2009

Pass the bill.

Howard Dean and the netroots left (the DailyKos crowd) are screaming bloody murder about the current incarnation of the health care reform bill. They say it's no longer worth voting for. My father sent me an email agreeing with that position, and I figured I would post my reply here, as it is a good look at my thoughts on the issue:

I have to disagree. Previous failures at reforming health care have not led to improvements over time. Each time reform fails, the next attempt is less ambitious. (Truman wanted single payer. After a few more failed attempts, this bill is all we can get. What would we get next time? History shows it would be worse.) Democrats will almost certainly lose seats in both the Senate and House in 2010. They probably won’t lose the majorities, but in the Senate, any loss is a huge blow. And remember, the house bill passed with just one vote to spare. Polls show the Democrats losing support if they pass HCR… but losing even worse if they don’t. Scrapping it now makes the 2010 midterms more likely to be a bloodbath for Dems, which will make reform even less likely.

This bill will provide health insurance for 30 million Americans that didn’t have it before. It is sprinkled with pilot programs for cost-cutting that can be ramped up if they work. It sets up exchanges to introduce actual competition between insurers, which didn’t exist before. It will give consumers standardized fact sheets, to more easily compare different plans and insurers. The hateable Joe Lieberman is working with the distinguished, respected, and very liberal Jay Rockefeller to improve the Medicare Commission to help keep Medicare spending down. It provides hundreds of billions of dollars in subsidies to help low-income families afford health insurance.

There are disappointments. Annual limits have not been outlawed. There’s no real movement toward changing the incentive structure for providers, which is a huge part of why costs continue to go up. Cleveland Clinic and Mayo Clinic provide a great model for low-cost, high-quality health care. They pay their doctors salaries with incentives for results, not for the number of tests ordered. That model should be extended to more hospitals. Obviously a public option would be better to provide more competition and bring costs down further, but my thoughts on that have been put on my blog a couple times.

I don’t mind insurance companies profiting if the end result is that people who couldn’t get insurance can get it now. Would I like a stronger bill? Of course. But in this political environment, I think you have to pass this bill and work on improving it over time. Scrapping it would most likely make future attempts even less ambitious.

Ezra Klein has a good argument for an individual mandate here:

Other Sources/Reading material:


  1. I'm still not sure any bill that passes will be better than nothing but I understand the importance of Obama getting something passed. But whatever happens need to happen quickly so the news changes to all the things Obama is doing to help create jobs and improve the economy.

  2. I refuse to accept the premise that this bill is NOT better than nothing. 30 million uninsured people will be insured. Nearly $900bn in subsidies will be paid to low-income families and individuals. That alone is worth it. And there is more in the bill than that.

  3. You are probably right but it is hard to tell since, as you have pointed out before, the media talks only about the process and the politics of health reform. They never actually discuss the actual provisions of the bill. The fact that the insurance industry still vigorously opposes it is a good sign.