First Thoughts
Earlier tonight a reader wrote to ask me to post some thoughts after the vote. My head is swimming—partly due to a case of the flu—so I don’t know if I can cover everything in one post.
To be honest, I’m not sure that my fevered brain can come up with words sufficient to the occasion. Ted Kennedy wrote before his death that universal health insurance was the major piece of unfinished work of our society. I have always agreed. One can certainly debate the appropriate scope of the modern welfare state, but I would argue that health insurance is a foundational part of it. It’s been clear for some time that the private health insurance market was going to collapse without significant reform and that this reform could not be pursued apart from efforts to reform our existing public insurance programs and transform our health care delivery system. Today’s legislation will not solve all the problems we face in health care, but it goes a long way toward solving the most important ones.
I also need to say for the record that I was wrong. I wrote a post in January where I said that health care reform had—once again—been defeated. I wrote that in the midst of the Democratic strategic meltdown in the wake of the Massachusetts Senate election. Based on my past experience, I thought the legislative window had closed. I was wrong.
It’s pretty clear that a significant amount of the credit for keeping the window open goes to Nancy Pelosi. From all accounts, some of President Obama’s chief advisors were advising that he start over with a more incremental bill. Pelosi argued with the White House in favor of a comprehensive approach and argued with her own caucus members who deeply disliked the Senate bill.
I would also say that—ironically—some of the credit for keeping the window open belongs to the Republicans. Their unified and unyielding opposition to any serious reform legislation convinced many moderate and conservative Democrats that the Republicans simply weren’t serious about reform. If even a few Republicans had been willing to break ranks—either last summer or after the January Senate election—they could have convinced enough moderate and conservative Democrats to embrace less sweeping legislation. The Republicans are hoping to be vindicated in the November elections, but there is no question they have suffered a stunning legislative defeat.
The historical irony of this is that—in many ways—this is a very Republican bill. Many of the elements of this bill—health exchanges, individual mandates, subsidies, etc—were embraced by President George Bush during the 1992 presidential race. While the financing is public, the delivery system and the insurance system remain private and the bill tries to leverage consumer choice and market forces to improve cost and quality.
There is a lot of implementation work that needs to get done now. One of the challenges the new law will face is that there are a lot of moving parts—setting up the exchanges, setting up the structure to administer the subsidies, getting rolling on the various Medicare pilot programs on delivery system reform. There is a lot of anxiety out there, so public education is going to be a critical component.
Nor are the politics completely over. I don’t think repeal is an idea with serious legs, but a number of Republicans plan to run in November on it. There will also be a number of court challenges, particularly on some of these state laws that have been passed to “nullify” certain aspects of reform. I tend to think that issue was settled at Appomattox 150 years ago, but the possibility of an activist decision from the Roberts court cannot be completely ruled out.
There are two people who are in my thoughts tonight who have gone to the Lord and who I wished were around to see this. The first is a guy named Bert Seidman, who was for many years the Director of Employee Benefits at the AFL-CIO. By the time I got to DC, Bert had retired and was serving as an advisor cum organizer for the National Council of Senior Citizens. Bert had been working on health care going back to the Truman Administration and had lived through many failed attempts at health care reform. After reform went down to defeat in 1994, I thought of Bert a lot. I figured that if Bert could keep working for this after so many failed attempts, I shouldn’t complain. Bert died in 2004.
The second person who is in my thoughts is the woman who first got me interested in health care, Peggy Connerton who was Director of Public Policy at the Service Employees International Union. She hired me right out of graduate school in 1993. The funny thing is that she promised me that I’d be able to work on policy issues other than health care, which was not my major interest at the time. Peggy was a little economical with the truth there, because I was swiftly swept up into the campaign for health care reform and there was little time for anything else. But I had the time of my life travelling around the country, going to the White House for meetings, and writing reams and reams of Congressional testimony and briefing papers. I would not be working in health care today if not for that experience. Peggy was diagnosed with breast cancer in 1995. She died only three years later, and it was hard to lose someone who had been both a mentor and a friend.
So Peggy and Bert, this one’s for you. You were footsoldiers in America’s army of conscience. We couldn’t have done what we did tonight without you.
Peter, many thanks for your incredibly and constructive informative posts — even semi-delirious you are more clear-headed and informed than the rest of us, or me, to be sure.
On another level, I also wonder if this isn’t also a critically important victory for the principle of governing and government. That such legislation could be accomplished in this polarized atmosphere seems critical to the very idea of democratic governance and of opening the door to other reforms.
I see that Cardinal Mahony as a WaPo op-ed on immigration reform — already, perhaps the focus shifts.
David Frum is clear-eyed as ever:
Nor are the politics completely over. I don’t think repeal is an idea with serious legs . . .
What do you mean?
The House just voted to amend, i.e. repeal and replace, several sections of the same bill that they moments before voted to enact.
But, of course you are right — that whole reconciliation “fix” is a scam, just like passage of the Stupak Amendment was a farce from the very beginning, and it does not have serious legs — it was never intended to — the Senate will now move on to other things, never bothering to get to the reconciliation bill.
Peter,
I second David Gibson’s warm appreciation for your most helpful analysis and comments these days.
I would quickly make three points:
1. your invocation of your “mentors” was touching — quasi-eucharistic;
2. regarding the EO (which Kathy transcribed on your thread below), if it is “symbolic,” it strikes this untutored reader as rather substantively symbolic (the Catholic both/and again?);
3. I sincerely hope that Bender is neither a prophet nor the son of a prophet!
And compliments to Mr. Gibson for his fine and rapid analysis on Politics Today:
http://www.politicsdaily.com/2010/03/22/how-the-bishops-lost-even-as-their-cause-prevailed/
I think it is quite telling that much of what is in this bill had previously been sponsored by Republicans without objection when the GOP did it. And several of the “pro-life” groups had no problems giving praises to GW Bush and giving him awards despite his 1) federally funding ESCR and 2) increasing Planned Parenthood funding. The fact is, one can see how they will not yell “baby killer” to their own political favorites, even when they do the same or worse. It shows it is politics, not about the baby after all.
“The Bishops lost even as their cause prevailed.”-David Gibson on Politics Today
Their cause, from the beginning, was an inclusive Health Care Plan, one that would provide quality and affordable Health Care for those Human Individuals residing inside their Mother’s Womb as well as those Human Individuals residing outside of their Mother’s Womb.
Both/and is the Catholic position and yet, you are surprised by this?
Peter Nixon, thanks for the forum. I enjoyed your play-by-play on the previous thread while I watched the CNN feed live. Feel better soon!
And several Hail Marys for Bart Stupak. In trying to work within the party, he may be able to change it. I’m not sure he got the credit he deserved for bringing into fuller light the policies of insurance companies that cut people’s health care when they start looking a bit risky.
With apologies in advance to John Borst for my pessimism–I think the celebrations are premature. There are some good things that will kick before November elections–children’s coverage, college student coverage, rebates for the elderly on prescription meds.
But the 30 million of us without health care will continue to be out of luck for the next four years, and that’s the best case scenario.
Consider that in the next four years:
–6 million people will be diagnosed with cancer (based on the American Cancer Society’s estimated 1.5 million new cases of cancer in 2009). That doesn’t count those who are already sick and trying to get treatment.
–6 million people will be diagnosed with diabetes (based on American Diabetes Association figures). That doesn’t count those who already have the disease and are trying to manage it.
–31 million people will have heart attacks (based on the American Heart Association’s data for 2004 of 7.9 mlllion MI’s per year). That doesn’t count those who need expensive meds to control cardiovascular disease.
If you figure that 10 percent of those people have no insurance, roughly the rate of uninsured Americans, that’s 4.3 million people who will get a catastrophic or serious diagnosis in the next four years without any insurance to help with care and treatment.
In addition, a 2009 Harvard study noted that 43,000 people in the U.S. die because of a lack of access to health care. That means 172,000 deaths in the next four years if that study is correct. (http://prescriptions.blogs.nytimes.com/2009/09/17/harvard-medical-study-links-lack-of-insurance-to-45000-us-deaths-a-year/)
Aside from the delayed assistance to those without access to insurance and GOP vows to make overturning the bill their rallying cry in November (per John McCain this morning on ABC), the real clout in the health care bill–a government option–was cut long before it ever came to last night’s vote. That measure would have provided competition for private insurance companies, in my view the surest way to keep premiums low.
Requiring people to buy insurance and ensuring that they will not be dropped in the event of a catastrophic illness, is NOT the same as ensuring that health care insurance will be any more affordable four years from now or that if people get sick, their rates will not be jacked up beyond their means to pay.
Conceivably, people who fail to qualify for Medicaid could fall into a nightmare scenario where they are unable to afford required insurance and must pay the 2 percent fine for not purchasing it.
The health care bill, at best, shows that the Democratic Party still believes government should be concerned with the well-being of the most vulnerable Americans and can muster the votes to squeak through a fairly weak bill that purports to do that.
I hope to be convinced that the bill will survive and will actually do people some good four years from now. But I’m not overly optimistic.
What’s next on the agenda for health care advocates?
Jean, your view is indeed pessimistic. Not having read the Bill, why will it take four years to click in for you if it makes it that far?
It really was an education watching the House in action for the first time. Having the live blog was a major bonus. As a former educator I thought what a great way to educate young people on how America’s system really works.
I think they would have been amazed by the minority leader’s immediate attempt to undo the Bill. I was shocked. I was also shocked by the lack of party solidarity on the part of the Dems. In a parliamentary system, without the PM first announcing a free vote that just would not happen.
I think as Peter described above the fact that the Dems didn’t collapse as happened with Clinton is worthy of the Congratulations I expressed last night. I simply had no idea that it would take that long to implement. Maybe someone can explain.
“I simply had no idea that it would take that long to implement. Maybe someone can explain.”
Eh, it’s an accounting trick. You front-load on taxes for four years, while offering limited benefits. It makes things seem more affordable. Just google “health care” and “accounting” and “4 years” and you’ll find a better explanation.
John Borst, rebates for drugs and allowing kids to stay on insurance policies through age 26 will kick in now. In a few months insurance companies can’t deny kids for pre-existings.
But the main piece–requiring people to purchase insurance or face fines in exchange for an unknown amount of assistance in the face of unknown prices for policies–will not kick in for four years.
Always scary when I find myself agreeing with “Adeodatus” or “God’s Gift” or whoever he is, but there ya go.
Jean, be not afraid. And the name is only a nod to Augustine, nothing more.