Healthcare Reform... What Next?

[chinaco]

Looks like the big plans for sweeping health care reform are not gonna happen.

Still... some believe there will be some sort of health care reform.

What do you think is going to happen?

My money is on some marginal "do nothing" bill that allows all sides to claim they fixed it.

 

[Gone4Good]

My money is on some marginal "do nothing" bill that allows all sides to claim they fixed it.

That's what I'm afraid of. Some are recommending a bill that simply prohibits exclusions for pre-existing conditions. If that's all they do then even healthy people will no longer be able to afford coverage.

 

[donheff]

Maybe nothing, but maybe a major comeback. Pelosi and company are working on a deal that would have the Senate use reconciliation (a simple majority vote, no filibuster allowed) to pass a modification to the existing Senate bill to set up a national (not state) exchange, scale back the tax on Cadilac plans, and a few other modifications. The House could then ratify the existing Senate plan, ratify the reconciliation modification and send the package to the President. No more just say no GOP and no more Nelson, Lieberman, Lincoln, Landrau hostage situation. If Pelosi and Reid are unable to pull this off, they will lose their base. If they do pull it off, the loyal opposition will squeal like stuck pigs but the elections (2010 and 2012) will turn on what they will turn on in any case -- the economy.

 

[FinanceDude]

It is a little unnerving that the orginal bills passed the Senate and House with not ONE Republican vote. Either it was to make a point, or the bill is so bad they couldn't stomach voting for it...........

I heard the Senate majority foks said NO VOTE would be taken before Sentator Brown is seated. If they go the reconciliation route, and don't let Brown vote, I'm not sure the Dems want to take that risk.....it could backfire in a huge way..........

Why is reform ALWAYS an all or nothing proposition? It seems to me the best way to eat an elephant is one bite at a time....

 

[samclem]

The status changes by the minute, but it appears that Speaker Pelosi and Senator Reid are putting this issue on the back burner. From the NYT (26 Jan):

WASHINGTON — With no clear path forward on major health care legislation, Democratic leaders in Congress effectively slammed the brakes on President Obama’s top domestic priority on Tuesday, saying they no longer felt pressure to move quickly on a health bill after eight months of setting deadlines and missing them.

The Senate majority leader, Harry Reid, Democrat of Nevada, deflected questions about health care. “We’re not on health care now,” Mr. Reid said. “We’ve talked a lot about it in the past.”
He added, “There is no rush,” and noted that Congress still had most of this year to work on the health bills passed in 2009 by the Senate and the House.
Mr. Reid said he and the House speaker, Nancy Pelosi, were working to map out a way to complete a health care overhaul in coming months.
“There are a number of options being discussed,” he said, emphasizing “procedural aspects” of the issue.
At the same time, two centrist Democrats who are up for re-election this year, Senators Blanche Lincoln of Arkansas and Evan Bayh of Indiana, said they would resist efforts to muscle through a health care bill using a parliamentary tactic called budget reconciliation, which seemed to be the easiest way to advance the measure. The White House had said in recent days that it would support that approach.

Hopefully, whatever finally gets done (by either party) will be accomplished in an open, transparent way. Whatever the merits of the House and Senate bills, there's little doubt that the process used to build that legislation and get it passed alienated a lot of people. And I think politicians (especially ones up for re-election) are unlikely to trust the advice they are getting from some quarters to pass unpopular legislation in hopes that their constituents will eventually come to like it. Nope, things go a lot easier if you convince the voters before signing the law.

If done right, change of this type is more likely to endure than change that is based on more limited public acceptance.

 

[donheff]

Why is reform ALWAYS an all or nothing proposition? It seems to me the best way to eat an elephant is one bite at a time....

There are no small fixes. For example, you can't do away with pre-existing conditions without mandating healthy young people's participation unless you want to accept massive premiums for those who need insurance. And the same goes for most piecemeal changes - one thing influences another.

T
Hopefully, whatever finally gets done (by either party) will be accomplished in an open, transparent way.

If done right, change of this type is more likely to endure than change that is based on more limited public acceptance.

I like the sentiments but they would only work in an environment that doesn't include the Senate filibuster or in which the parties somehow would come to agree that if a transparent process was used no filibuster would be invoked. In other words, partisans would have to be willing to let a package they despise come to a vote. Unfortunately, that is a pipe dream now with a GOP minority and in 2011+ with (potentially) a DEM minority.

Bottom line, if this Congress can't slip comprehensive health reform through quickly we will not see it for decades.

 

[samclem]

I like the sentiments but they would only work in an environment that doesn't include the Senate filibuster or in which the parties somehow would come to agree that if a transparent process was used no filibuster would be invoked. In other words, partisans would have to be willing to let a package they despise come to a vote. Unfortunately, that is a pipe dream now with a GOP minority and in 2011+ with (potentially) a DEM minority.

But we've enacted very broad and controversial legislation in the past and the threat of fllibuster didn't stop it. The exact number of votes needed for cloture (to end a filibuster) have varied over the years (the present "3/5's of sworn senators" was enacted by the Dem controlled senate in 1975), but the rules haven't changed much. Somehow we we got welfare reform, Medicaid, Medicare, etc. I think the trick is, with these very major laws, to achieve a high degree of consensus across the spectrum. That's probably a good thing--when we're talking about a lot of money or big structural changes, there should be a lot of broad buy-in. Unfortunately, this is hard today due to the partisanship and lack of trust on all levels.

Bottom line, if this Congress can't slip comprehensive health reform through quickly we will not see it for decades.

I guess the "good" news is that our present "system" is so screwed up and costs (to society, businesses, and individuals) are escalating so rapidly that we can't afford to wait very long to fix things. At least there is broad consensus that US health care needs reform, it's only the type of reform that is subject to debate. Hopefully, this latest painful dust-up will motivate even the most conservative legislators to recognize that whistling past the graveyard will only increase the likelihood of a very bad "fix" later on.

 

[ziggy29]

Somehow we we got welfare reform, Medicaid, Medicare, etc. I think the trick is, with these very major laws, to achieve a high degree of consensus across the spectrum. That's probably a good thing--when we're talking about a lot of money or big structural changes, there should be a lot of broad buy-in. Unfortunately, this is hard today due to the partisanship and lack of trust on all levels.

I tend to agree. The bottom line is that this health care bill -- both the House and the Senate versions -- had *none* of the significant items on the minority party's "wish list." As far as I can tell, many of their proposals were treated as DOA by the Congressional leadership.

At this point, if the president and the majority party want comprehensive health care reform, they are going to have to throw some bones to the minority party. As someone who prefers (when possible) consensus and compromise over single-party dominance, I think that's a good thing provided leaders on both sides would commit to doing this in good faith. Then again, "good faith" across party lines is all but extinct these days.

Oh, and real transparency with no special deals to secure votes or special interest support would be a good selling point, too.

 

[ziggy29]

Why is reform ALWAYS an all or nothing proposition? It seems to me the best way to eat an elephant is one bite at a time....

I see where you're going, but sometimes things have to be tackled together. As donheff mentioned, you can't "solve" the underwriting/pre-existing condition problems without a universal coverage mandate. And you can't have a universal mandate without devising a way to pay for it that doesn't send people out into the streets with torches and pitchforks.

Ultimately, though, my biggest beef with the now-threatened health care proposals (other than the outrageous backroom deals) is that it failed to really address the biggest problem: cost containment. We can say we've covered everyone all we want, but if we do nothing to stop the 10-15% annual cost increases, that's a hollow and unsustainable victory.

And I think it would be easier to address the underwriting and universal mandate concerns if cost containment measures were in place first. Fix the runaway inflation problem and *everything* else becomes a lot easier.

 

[easysurfer]

Maybe we'll get some more clarity after tonight's state of the union address. We shall see.

As for now, it seems like one side wants to pass something no matter how slimmed down the bill eventually gets or can't even work among itself without fighting, while the other side wants to kill it at all costs. All with political agendas in mind.

The political jockeying that has gone on reminds me of the scene in the movie "Big" with Tom Hanks when during the presentation, John Heard intentionally raises his hand and says "I don't get it".

Makes one wonder if nothing gets down about health care reform this time around, would anyone try again. If social security is the third rail of politics than maybe health care reform is right next to that rail.

 

[ziggy29]

Makes one wonder if nothing gets down about health care reform this time around, would anyone try again. If social security is the third rail of politics than maybe health care reform is right next to that rail.

My personal belief is that we have become irreversibly polarized and -- if anything -- it's only going to get worse, and here's why.

I think the primary driver of this is that technology has created the small-d "democratization" of media, and it became feasible to get many alternative (and often strongly biased) "new media" outlets out there. Be it cable news, talk radio, bloggers, the Internet, you name it -- it's never been easier for a consumer of current events and analysis to avoid being forced to think outside their own ideological "comfort zone." The market share of the "old media" -- which, while not perfect, was much closer to unbiased and objective than most new media -- has dropped sharply as media sources with a decidedly partisan and ideological perspective have gained.

When all the "news" you read merely reinforces what you already believe, it becomes easier and easier to dismiss alternative viewpoints (and those who hold them) as stupid, evil or both. Lather, rinse, repeat. Our "team" good, their "team" bad. And I use the word "team" intentionally; rather than what's best for the country, it's all about my "team" winning over our hated rivals. We've become Yankees and Red Sox, Michigan and Ohio State, Alabama and Auburn.

It colors all the major debate points of our time, including health care. Perhaps even *especially* health care.

It's great that more points of view can get out there and we're not "hostage" to the big old media, but in hindsight they did a lot better job of being objective and non-partisan than the new media. So in the end, I'm not sure we're better off with a more fragmented, democratized and egalitarian media. And I sadly don't see ANY way out of that abyss.

 

[samclem]

My personal belief is that we have become irreversibly polarized and -- if anything -- it's only going to get worse, and here's why.

Agreed. While people choosing to read/listen to opinion pieces that confirm their world view is nothing new, at least in the past we were all exposed to the same fairly neutral set of facts and observations to serve as a point of departure. Now there's less and less of that. If people can't agree on the basic situation that needs fixing, there's there's less hope of building consensus for action.

A related tidbit: A new poll from Public Policy Polling found that of the TV networks Fox news was more trusted by Americans than any other network.

Americans do not trust the major tv news operations in the country- except for Fox News.

Our newest survey looking at perceptions of ABC News, CBS News, CNN, Fox News, and NBC News finds Fox as the only one that more people say they trust than distrust. 49% say they trust it to 37% who do not.

CNN does next best at a 39/41 spread, followed by NBC at 35/44, CBS at 32/46, and ABC at 31/46

Now, some will view this as evidence that the American people are rubes and simpletons, and some will say that it is evidence that the other networks have lost the trust of Americans for various reasons.

But, then we have this from White House Communications Director Dan Pfeiffer:

"We don't feel the obligation to treat [Fox] like we would treat a CNN, or an ABC, or an NBC, or a traditional news organization, but there are times when we believe it makes sense to communicate with them."

Yep, this "boutique news" thing is not good for us.

 

[easysurfer]

I still think the health care debate goes to the core question , "Is health care a fundamental right or a privilege". I think most would agree that every citizen should have afforable health care in the country. But how that should come about, especially with so much politically at stake blurs things a lot.

 

[samclem]

I still think the health care debate goes to the core question , "Is health care a fundamental right or a privilege". I think most would agree that every citizen should have affordable health care in the country.

To assert that health care is a "right" is a big leap, at least from anything in the US experience. To the degree that Mr Smith believes he has a right to something and uses the police power of the state to take things from Mr Jones to provide these things, the rights of Mr Jones to his own personal property are diminished. To the degree that Mr Jones used his talents and his time to get these things in the first place, in a very real sense, a portion of Mr Jones's life was taken from him and given to Mr Smith. Is that "right?" Where does it stop? Can Mr Smith just vote himself more and more things at the expense of Mr Jones?

 

[IBWino]

I think a proposal by someone on this forum (I forget who; maybe ziggy) that is worth consideration is a two tiered approach with some form of nationalized catastrophic health insurance, and a mandate requiring people to obtain private insurance to cover everything else. I'm not sure how this might be funded or its impact on costs, but it seems worth investigating.

 

[easysurfer]

To assert that health care is a "right" is a mighty big leap, at least from anything in the US experience. To the degree that Mr Smith believes he has a right to something and uses the police power of the state to take things from Mr Jones to provide these things, the rights of Mr Jones to his own personal property are diminished. To the degree that Mr Jones used his talents and his time to get these things in the first place, in a very real sense, a portion of Mr Jones's life was taken from him and given to Mr Smith. Is that "right?" Where does it stop?

Point well taken, but to be the devil's advocate, if Mrs Flowers has the same serious cancer as Mr. Jones, but wasn't as fortunate to have the same resources as Mr. Jones, is it okay as a nation to say she should not have the opportunity to get the same treatment as Mr. Jones? That is, better care for the higher class than middle and lower class.

 

[FinanceDude]

Point well taken, but to be the devil's advocate, if Mrs Flowers has the same serious cancer as Mr. Jones, but wasn't as fortunate to have the same resources as Mr. Jones, is it okay as a nation to say she should not have the opportunity to get the same treatment as Mr. Jones? That is, better care for the higher class than middle and lower class.

There is some social disparity, but I don't see that becoming more equal under a govt run health care plan. One of my clients is a cardiologist, and has done 50+ surgeries on Canadien citizens in the past 2 years.......seems that "non-critical" procedures have a 2-3 year wait, so those folks took their cash and paid for it to be done in the US rather than wait...........

 

[easysurfer]

With the hippocratic oath, I believe doctors and health professions should and do their best to treat each one the same regardless of social disparity. However, without some type of overhaul that works, I'd think their still would be a large disparity as to who can afford insurance and is insurableable versus those who cannot afford and obtain insurance.

 

[Texas Proud]

I see the major problem (and I don't want to get off topic) is there is very little middle ground... the Dems want universal coverage. They do not want to fix the current system because they think that everybody should have equal access to healthcare...

The Repubs want a free market system... with regulations... less government for the people... (well, to a point)...


As many have pointed out... including ME a number of times... neither of these is what the American people want right now... we want someone to address the COST of the system. Making young healthy people pay for the medical needs of the old unhealthy people does nothing to change the costs.

Putting in place a huge transfer of wealth so everyone can have 'healthcare' is just wrong (IMO)... and what about the people who have health care but choose to blow their money on something else... again, stories have come out about the people who have to go wait in line to get free healthcare from some charity.... but then they slip up and say they have health insurance, but can't pay the copay...


I have a problem in thinking of solutions to address the costs... it is very widespread... and there are no incentives to get it fixed by the people who produce the costs as they benefit... and the consumer has very little say on what is paid... they (we) just go along with whatever is said..

Who wants to NOT pay for medical care and live with the negative outcome, or not live in some cases...

 

[Gone4Good]

I tend to agree. The bottom line is that this health care bill -- both the House and the Senate versions -- had *none* of the significant items on the minority party's "wish list." As far as I can tell, many of their proposals were treated as DOA by the Congressional leadership.

At this point, if the president and the majority party want comprehensive health care reform, they are going to have to throw some bones to the minority party.

I guess you missed the 160 Republican amendments that were accepted as of July . . .

This Is What "Bipartisanship" Looks Like

And I guess deep-sixing single payer, a public option, or medicare buy-in proposals somehow don't count.

Here's apparently what Olympia Snowe wanted in September . . . What Does Olympia Snowe Want? The only thing that's on that list that is not included in the Senate bill is to reduce the subsidy threshold below the 400% of poverty level. When it came time to vote for the Senate bill she said she would vote "no" because she didn't have enough time to review the bill. Well she's had plenty of time now. And seeing as how the bill includes almost everything she was negotiating for maybe we can count on her to be the 60th cloture vote.

Maybe you could give us an example of something that could be added, or subtracted, to the existing bill that would be sufficient to capture even one Republican vote.

 

[Gone4Good]

But we've enacted very broad and controversial legislation in the past and the threat of fllibuster didn't stop it.

The filibuster was never used the way it is used currently.

 

[samclem]

The filibuster was never used the way it is used currently.

Is the increased use of the threat of filibuster a symptom (of increased partisanship? Of legislation that deviates so far from the mainstream that the minority can't abide it?) or is an evil in itself that must be addressed?

The rule itself hasn't changed in over 30 years. It has been available for use by both parties for even longer than that. So, what has changed? The GOP legislators certainly wouldn't see it as being in their self-interest to filibuster laws that their constituents support.

 

[Gone4Good]

Of legislation that deviates so far from the mainstream that the minority can't abide it?

You mean like . . .

Reappointment of Fed Chief Ben Bernanke - filibustered
Raising the debt ceiling so the US doesn't default - filibustered
A Bipartisan deficit reduction commission- filibustered
Extending unemployment insurance - filibustered
2010 defense spending bill - filibustered (yup, that's right. The GOP filibustered the defense appropriation bill)
etc
etc

 

[samclem]

You mean like . . .

Reappointment of Fed Chief Ben Bernanke - filibustered
Raising the debt ceiling so the US doesn't default - filibustered
A Bipartisan deficit reduction commission- filibustered
2010 defense spending bill - filibustered (yup, that's right. The GOP filibustered the defense appropriation bill)
etc
etc

Well, to be precise, none of these items were filibustered. To find a real recent filibuster, a student should climb into the wayback machine and scoot back to 2003. There we'd find none other than Senator Harry Reid talking for 8 hours to help block one of President Bush's judicial nominations.
The present friction between the parties goes back well before President Obama.

Anyway, many of the items cited were jammed through despite valid concerns from the other side. E.g.
-- Debt ceiling--why was new debt ceiling set so high? Answer: So it would get us through the 2012 election without having to come to a vote again, reminding voters of the runaway spending.
-- "Debt reduction commission": A means for Congress to brazenly abdicate their responsibility. Congress should do its job.

 

[Gone4Good]

Anyway, many of the items cited were jammed through despite valid concerns from the other side.

So you've changed the argument that the minority party is using the filibuster to stop "legislation that deviates so far from the mainstream that the minority can't abide it" to simply stopping any legislation where someone has "valid concerns". Suffice it to say that it is nearly impossible to write a piece of legislation where at least 1 senator doesn't have "valid concerns" of some kind. So you're basically setting a standard by which all legislation needs the support of a super majority to pass.

-- Debt ceiling--why was new debt ceiling set do high? Answer: So it would get us through the 2012 election without having to come to a vote again, remindding voters of the runaway spending.
-- "Debt reduction commission": A means for Congress to brazenly abdicate their responsibility. Congress should do its job.

And in these instances its not really even "valid" concerns, but political concerns at issue. By your reasoning the minority party is using the filibuster to force frequent votes as a reminder of our runaway deficit and simultaneously using the filibuster to block a really effective way of reaching the compromises necessary to bring those deficits down.

And you support that line of thinking?