Amidst all the crazy health care negotiations, one thing to keep your eye on is this: Will the Senate Finance Committee come to dominate the process. Multiple congressional committees are working on health care, all with their own ideas. But the Senate Finance Committee is probably the most important to watch because its chairman, Max Baucus, the Montana Democrat, has vowed to produce a bipartisan bill. Other bills incorporate Republican amendments but that's not quite the same thing. Anyway, I bring all this up today because Baucus announced this afternoon that they have a bill that keeps the cost under $1 trillion and is all paid for--mostly through Medicare cuts. It eschews the so-called public option that Democrats and the administration consider so essential to reducing costs and getting insurance to the uninsured.
Intellectually, the public option still makes a lot of sense as a bludgeon to the insurance comapnies. But the Finance Committee version still feels like the one that'll emerge victorious from this Darwinian struggle. It's going to annoy a lot of Democrats but they could wind up signing on to it anyway.
In any event, it's worth thinking of health care not as a one shot deal but as an ongoing process. Medicare is still being modified 40 years later. The idea that we'd get to universal care in one year--even if it's one big year--was always a little unrealistic.
This process will go on for awhile, into the fall. But the Finance Committee version still feels like the one to watch. And the question is not whether we get full health reform this year but if we get some of it or none at all.
No, Finance isn't the one to watch. Waxman has come to an agreement w/the Blue Dogs that takes a 100 billion off the bill; bringing it under a trillion while preserving the public option. The CBO has said the public option won't destroy insurance and that is an irrational fear. Baucus is the last one out the gate and simply because of that has done one thing; delayed the process. At the same time; he's insured that reformers rally around a public option and circle the wagons around the House bill.
Things will move towards the center; but Pelosi/Waxman have delivered a bill from the House that goes far enough to the left that there is room for negotiations so centrists can say I did a, b, and c for you while keeping the core of real reform: public option for insurance exchange to occur, universal coverage, insurance mandates, and that insurance can't discriminate for a pre-existing condition.
Right now, the campaign btwn Obama/Clinton is paying off for the party once again in the form of the millions spent and education done on health care. The ground works been laid and I really feel a historic legislation is coming down the pike with real fundamental reforms.
This is Obama's Medicare moment and the significance of that can not IMO be understated in regards to 2010 and 2012. It's why the WH will go done to get a public plan and why at the end of the day Democrats will circle the wagon.
It's been very bumpy. But, in taking so damn long the Finance committee has actually done harm to the lobbyists that I don't think they yet see. 76% in favor of a public option ain't chump change. By being last out of the gate, predictable, with a plan that does less and saves comparatively little when put next to the HELP bill Baucus has made himself irrelevant. And he pissed off the liberals on the committee. He's been in a box with Grassley and seems oblivious to the real debate that has been occurring outside.
I could go on forever, and have (lol). But I feel good today and more zen than I did yesterday; and I felt pretty damn good yesterday.
Curious - how does the public option, with which any 'non-greedy' health insurer should be able to compete, address all of the varying rules in each state as to what services health insurance must cover?
I hoping this turns out to be Baucus' "Waterloo." Becoming blood-brothers with Grassley (who couldn't even bring himself to vote for Sotomayor in the Judiciary) to protect their seats at the top will come at a political price.
Something else to watch out for: Ted Kennedy in defense of the HELP bill. I think it would be foolish to discount his political capital in all of this, and god-willing, he'll have the strength to cash it all in when the time comes.
3 of the 4 main bills in Congress contain the public option. If 6 Senators on the Finance Committee and their special interest-padded seats win out in conference committee, then it will be an indictment of a flawed legislative process rather than an indication of a lack of public support for fundamental Healthcare reform.
I wonder how many of the "public option" supporters are actually out in real America and not in Washington.
The NY Times just issued an alert headlined "Poll Shows Obama's Clout on Health Care Is Eroding." It indicates that "Americans are concerned that overhauling the health care system would reduce the quality of their care, increase their out-of-pocket health costs and tax bills and limit their options in choosing doctors, treatment and tests, the poll found."
The problem for the democrats is that all of these concerns are likely correct. They are rightly skeptical of the "ponies for everyone" message that the administration is trying to sell.
Except, if you actually read the article and look at the poll, you find out that the headline is grossly misleading. Americans have concerns but still support the measure overall. Obama is still trusted far more than anybody else in either party on health care - even if less than a month ago.
Obama's clout isn't eroding at all. What he does with his clout has been up for debate all along. Should he speak more? Speak less? Lay out specifics of a plan that hasn't been finalized? Etc. But his voice is still far more important than any other.
I am afraid The Industry is once again hijacking public policy for profits. Forcing people to buy a commercial product (health insurance) and using taxpayer money to subsidize those who can't afford it, is NOT reform. Furthermore, by design, the public plan option will struggle because the sickest most expensive patients will gravitate to it. Not only that, it won't be available until 2013. Years later, when it fails, The Industry will point to it as proof the Single Payer won't work. It will be the wrong lesson. In the meantime, our health care non-system will continue to break or fragile bank. I don't know about you, but this is bad for my blood pressure.
Oregon PNHP is going to do something about this. Visit MadAsHellDoctors.com to find out more.
Paul Hochfeld, M.D.