Good news and bad news last night, as the House passed health care reform.
The good news is: the House passed health care reform. The work isn’t completely done yet, of course. The House had already passed a heath care bill, months ago, but this isn’t it; last night they passed the Senate’s version of the Bill, which had some glaring flaws. Under ordinary circumstances the House and Senate would get together and hammer out a compromise between their two bills. But in the meantime Republicans picked up an extra Senate seat in Massachusetts after Teddy Kennedy died, and they had promised to filibuster the compromise package. (Because, after all, what courageous moral stand could be worth invoking arcane parliamentary procedures more than the fight to prevent millions of people from getting health insurance, especially if that was the life’s goal of the Senator whose death allowed you to improve from having twenty fewer votes than the opposition to only having eighteen fewer votes?)
So Obama will sign the Senate bill that the House just approved, and then the Senate will consider a reconciliation bill also passed by the House last night. Under even-more-arcane procedures, the reconciliation measure can be passed without threat of filibuster. It requires only “majority vote,” a quaint notion in this highly baroque age.
It’s not an especially huge bill, whatever you may have heard, but it will have an impact. Here is a list of the major impacts, and an interactive graphic to figure out how you will be affected. The most important features seem to be:
- Establish health insurance exchanges, and provide subsidies for people below four times the poverty line.
- Guarantee insurance for people with pre-existing conditions, and eliminate “rescissions” that take away insurance from people who get sick.
- Push business to provide insurance for their employees, and self-employed individuals to buy insurance for themselves.
- Close the “donut hole” in the existing Medicare payout structure.
- Implement cost controls (mostly through slowing the growth of Medicare spending), thereby lowering the budget deficit by $130 billion over the first ten years, and by another $1 trillion over the next ten years.
Overall, it’s a relatively incremental bill, placing bandages over some of the more egregious wounds in the current system, while leaving in place the essential structure through which we funnel billions of dollars to middlemen while paying far more for medical care per person than any other country without getting better results. For 90% of Americans, coverage and insurance will continue as before. Basically, this brings us a little closer to where Western Europe was a century ago.
Still, a tremendous political accomplishment — maybe not from the perspective of what we were hoping for when Democrats took control of both houses of Congress and the Presidency in 2008, but certainly from the perspective of the last couple of months, when it often seemed like we weren’t going to get anything at all. More than anyone, credit for the accomplishment goes to Nancy Pelosi, who didn’t give up when things looked grim. From now on she won’t simply be known as the first female Speaker of the House, but one of the most effective leaders in its history. Here she is marching to the Capitol yesterday, arms linked with civil-rights pioneer Representative John Lewis from Georgia, carrying the gavel that was used when Medicare was passed in 1965. An historic moment.
Which brings us to the bad news. One of the reasons why Pelosi was marching with Lewis was to demonstrate support a day after this man who had marched at Selma was repeatedly called “nigger” by protesters outside the Capitol. Ugly by itself, but worse in context: it’s becoming harder and harder to have a meaningful debate in this country without participating in a race to the rhetorical bottom.
There exist reasonable arguments against health-care reform; not arguments I agree with, but ones that at least make superficial sense. It costs money to provide insurance for the uninsured, and someone will have to pay. Asking healthy people to buy insurance will be a burden to them. There will be less extra money floating around if we cut down on unnecessary costs, which might impede the pace of medical innovation. (I didn’t say they were great arguments, just that they made superficial sense.) But these aren’t the arguments that are actually made most frequently. Instead we hear that the Democrats are abandoning the principles of representative democracy by passing legislation while they control both legislative houses and the executive; or that liberals won’t stop until they have swept away the last vestiges of personal choice in American life; or that the government wants to decide when to kill granny. Right-wing bloggers nod with approval at the idea that people are stocking up on guns, preparing for fighting in the streets. The race to find the most scary and overheated characterization of a pretty benign state of affairs is a fierce one.
The most depressing aspect of the situation is not the existence of crazy fringe elements — those will always be with us, on both sides of any issue — but of the reinforcing dynamic between the fringe and the supposedly respectable parts of the Republican party. It’s been clear for a while to most people (outside the White House, anyway) that Republicans in Congress made a clear choice that their own self-interests are served by preventing Democrats from passing any meaningful legislation, whatever that might mean for the good of the country. Speeches during House “debate” last night consistently played to the worst aspects of the protesting mob. One Congressman shouted “baby killer!” at Democrat Bart Stupak, who is staunchly anti-abortion, as he spoke to support the bill. [Update: it was Randy Neugebauer (R-Tex.).] Two protesters inside the House chamber were arrested for being disruptive — and “several Republican lawmakers stood up and cheered during the interruption.”
Lest you think this is simply concern-trolling from a liberal telling conservatives to be less intrusive, note that conservative commentators like David Frum are making the same point: the rhetoric has gotten out of hand, and it’s not good for anybody, except maybe the “conservative entertainment industry.”
I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government. Talk radio thrives on confrontation and recrimination. When Rush Limbaugh said that he wanted President Obama to fail, he was intelligently explaining his own interests. What he omitted to say – but what is equally true – is that he also wants Republicans to fail. If Republicans succeed – if they govern successfully in office and negotiate attractive compromises out of office – Rush’s listeners get less angry. And if they are less angry, they listen to the radio less, and hear fewer ads for Sleepnumber beds.
I’m not sure what the end game is — whether it’s possible to step back to a more reasonable dialogue. Disagreement is good, and it’s important to have an active and engaged opposition party, no matter who the majority party might be. But whipping up hysteria at the cost of working together constructively isn’t in anyone’s interests. Obama campaigned on a message of hope and change and bipartisan togetherness, and I think that was a sincere message on his part; but it certainly hasn’t come to pass, and there doesn’t seem to be any indication that it will.
Great.
On the other hand, I’m faintly nervous about the domestic terrorism that is sure to spring up on the side of the idiots.
I do not see any concern about the ability to treat these additional 30 million+, nor for those who will lose the current level of healthcare when businesses drop employees insurance.
Looks like working taxpayers suffer and those who use tax money without paying are benefitted. Yes, we want to assist those in need, but how much will you do before your own familiy is hurt? Would you pay over half your weekly wage to the government to pay for increased costs of care?
Also what will happen when adding to these 30 million+ with the next push: immmigration reform. Let’s sink the boat? You drown as well.
What happened to pilot trial programs in several states to make the best plans? This was not the best way to implement a huge change!
Braemar, you’re going to have to cite your sources.
Sean, do you really think that Congress will vote to cut the Medicare reimbursement rate this year? If not, then the bill really is a farce in that it will not save us any money and will in fact add (and add big to the deficit). Keep in mind the doctor reimbursement rates were scheduled to drop on March 1st but Congress postponed it until the fall.
Yeah, unfortunately, things are really scary with people like that. Domestic terrorism, racist, hate propaganda. Really unfortunate in modern times.
But, we must stay strong! As Obama says we must have the Audacity of Hope!
Always remember, we as nation have come from much darker places in the past.
The Civil Right era, and before that, is an excellent example. People were sprayed with hoses, violently attacked and killed. The KKK used to be a reputable institution in the South. Hell, this country was founded with slavery!
Yet, the good prevailed. And the good and righteous will prevail again.
However, it is not without often immense sacrifice. Meaningful change is slow, painful, and requiring of undying endurance.
But, when one’s heart is filled with the an ocean of strength gained by helping others, you will not run out of strength to fight on!
Hopefully, non-violent, civil discourse, and cool-headedness will prevail.
I do believe the hate jabbering can appear louder in the ego-casting, multiplying internet age.
But people are also better informed and empowered these days. We can counter that BS. And I also like to believe (and hope is true) that for the most part people are only idly threatening violent actions. Voting conservatives into power is non-violent and democratic, so be it. But, threatening elected officials (or those who support them) with racial slurs and forced revolution is not acceptable.
It is an “absurd universe”(or Preposterous perhaps 😉 ) as Camus proclaims, but we must choose to fight for what we can best construct as ethical and good.
And importantly, it will not be easy.
but…
Yes. We. Can.
(ok, off soapbox! Cheers everyone.)
UchicagoMan, got any advice for someone who is occasionally scared of objecting in anything but the most tactful, placid-sounding terms (although I never agree with them) out of fear of getting beaten to death or possibly shot by one of these people?
I’m quite capable of doing it wittily, but I keep thinking if I say everything I want to say I’m going to end up in the hospital or in a small urn.
If I say everything I want to say about how wrong the conservative idiots are, I mean.
At this point there is only one way to get a more reasonable dialog out of the conservatives, and that is by this Fall’s elections. My best guess is that conservatives will continue with the divisive inflammatory rhetoric, obstruction in congress, and pandering to their crazy fringe constituents. However, if they have only limited success, if not outright defeat, at the ballot box, they will be forced to rethink their tactics. Perhaps they will realize that to have a constructive voice in our politics is to choose reason and compromise over temper tantrums.
I strongly encourage everyone to be engaged in politics, talk calmly and intelligently about issues with your friends and family, donate to candidates you like, volunteer for get out the vote drives, and do whatever you think is in the best interest for the entire country.
I was wondering whether to congratulate you on joining the second half of the twentieth century, but then you well and truly pre-empted me.
The opposition sounds rather like that which the British Labour Party received on starting the National Health Service in 1948. Then it took the Conservative leadership just three years to realise that they’d been making a bad mistake, and that any threat to undo the change would be a huge vote-loser. I wonder how long it will take in the USA.
Sean says, “…Because, after all, what courageous moral stand could be worth invoking arcane parliamentary procedures more than the fight to prevent millions of people from getting health insurance…”
Eh? Courage? Morals? Isn’t this all just part of the inevitable sequence of state space transitions predicted by the fundamental laws of physics? (I really liked your book, by the way.)
Sad thing is, Republicans saw the divisiveness they created during the Clinton administration as a win. They are simply upping the ante with Obama. Also sad, I think they’ll win in 2010 & 2012 because of it. There’s a lot of rightful anger out there that these tactics tap into. Wish people could see through the BS, but if they could we wouldn’t be where we are now. Not that the Democrats are really the solution to our problems either. The extreme right wing that calls itself the Republican party today is surely not it though.
About health care, I don’t like much about what I’ve heard about the bill. Anything that leaves our current insurers in place is a failure IMO. They are most of the problem to begin with. Should have just been a system where every citizen is covered. Yes, quality of care for those who have coverage now (like me) would probably go down some. I’m willing to wait an extra week or 2 on an appointment so that some family that couldn’t afford insurance can see a doctor. I’m afraid the “compromise” plan we have now is set up to fail. Half the bad things the Republicans argued against this bill have almost been guaranteed by this plan. The next step, which has already started, will be to tax every unhealthy thing they can think of so we can pay off the insurance companies without doing the politically inconvenient but right thing, raise income taxes (or fix the plan, but that’s not likely). That step will really bother me.
First, I think you’re summary and discussion of the bill’s merits is good. That said, it seems a bit hypocritical to complain about conservatives making accusations that “…Democrats are abandoning the principles of representative democracy by passing legislation while they control both legislative houses and the executive; or that liberals won’t stop until they have swept away the last vestiges of personal choice in American life; or that the government wants to decide when to kill granny,” when you start off the article by claiming that the motivation of Republicans in congress to oppose this particular bill was “…the fight to prevent millions of people from getting health insurance…” I agree that the discourse in Washington has sunk to new lows, but even Obama, when talking about it, makes it clear that both sides need to clean up their act.
I’m really disappointed in you, Sean.
I love this blog and bought your book. Reading your uneducated opinions on health care, health insurance, public entitlements, and the nature of the political debate is upsetting.
@Patrick:
What exactly where the Republicans fighting for then? To keep their insurance buddies happy? That’s much better. To protect the quality of care for the insured? Maybe, by keeping others from getting insurance. To keep government small? Maybe, but then that wasn’t a concern during the previous administration. At least the money now will help a few people instead of just blowing up foreigners.
@Brian:
Instead of just claiming Sean is uneducated, why not state why you believe so? It’d probably start a decent debate where a few people might learn something.
As a European citizen it ‘s beyond my understanding that there are still (mostly republican) people who are against it. We have these regulations since more than 30 years. I don’t know any single person (not even in the most right-side of politics) that would get rid of it.
Welcome to the civilized world America! You have a real great president!
A good, first and large step for the US to become a more civilized country.
I agree with your comments. Seems to me your recent book’s title would be an apt description of how long it has taken us to get to even this point in moving toward an improved healthcare system for this country. I realize this is a departure from your usual focus on cosmology but this is your blog. I’m glad you chose to speak your mind. I loved your Teaching Company course on Dark Energy and Dark Matter. Hope you have another sometime in the future.
My conservative friends are unshakeable in the ideological belief that there is a free market in medical care.Explaining that no one on an ambulance stretcher starts bargaining for the most cost effective hospital does not penetrate.
What will sink any plan which opens up medical care is that we need a lot more primary care physicians. But we have too few now. The slack has been brought up by importing Asian doctors, but , as in technology, fewer are coming, and some are returning.We have to subsidize medical education so that doctors dont graduate with debts of $120000 and get siphoned off into giving botox.
Yes, it’s true that the bill is not what we had hoped.
But non-passage of the bill would have been even less.
And if you’ve got a stone moving, you can try to re-direct it; but a stone that is sitting still is just not moving.
I was just going to make my one my smart aleck remark about determinism…but some of the other comments seem to be compelling me to submit again. 😉
Katherine: “If I say everything I want to say about how wrong the conservative idiots are, I mean.”
Jefke: “Welcome to the civilized world America!”
changcho: “A good, first and large step for the US to become a more civilized country.”
Wow. Really, that is how you start a dialog? Or are you rather just making arrogant statements in an echo chamber of folks that all agree with you?
I claim it is wrong to take by force the fruits of one person’s labor and redistribute them to someone else, no matter how noble the ends. I guess that makes me an uncivilized idiot.
Well then, Jeff, kindly stay off the road.
“I claim it is wrong to take by force the fruits of one person’s labor and redistribute them to someone else, no matter how noble the ends. I guess that makes me an uncivilized idiot.”
Do you disagree with the basis of every government on the planet, then?
Jeff, stay off off the (government subsidized) road and off the (government subsidized) internet
@Katherine:
Sorry, I was trying to state my principle in one line and don’t think I managed it. Roads and other public goods don’t count as redistributing value from one person to another. We can debate what public goods are so necessary as to justify taking resources from citizens to fund them. (You can probably guess that I’d be for keeping the list as short as possible.)
@Tom:
My explanation to Katherine might answer your query too…not sure. Taxes in general are problematic to me. But my concern would be reduced if revenue were not used for wealth redistribution and if the size of government were kept small. Given the present size of the US federal government I don’t need to look at the merits of *any* new spending program. I vote no.
@jpd: See answer to Katherine above.
@All Three:
My main point was to define my position as closer to those called uncivilized idiots than with most of the posters on this thread, to see if anyone wanted to call me nasty names too! Perhaps I am just too sensitive, but I see a tendency in supporters of more public spending on health care to consider anyone who disagrees to be stupid, ignorant, or worse.
Yes, roads and public services financed by tax revenue certainly count as redistributing wealth. The government takes money in the form of taxes and redistributes it in the form of services. Anyone can use the road, rich or poor. And if there’s a sidewalk (or you have a bike) then you don’t even need a car. Your theory is contradicted by experiment.
Many European countries have better healthcare than the US while spending less money on it. This holds true in single payer systems (such as the UK), and countries like the Netherlands and Switzerland that require purchase of private insurance. There’s no reason the US can’t do the same.
And I doubt anyone, yourself included, reading or replying to this blog is uneducated or unintelligent.