A Socratic Dialogue on Senate Sausage Grinding
December 20, 2009 by Robbie, under Blog.
Jeremy Pilaar: “Kill The Health Care Bill! Start Over!” – Howard Dean
Robbie Bruens: Yeah, because if we start over now we’re not going to end up waiting another decade or two. Killing a bill does not mean we will get bolder reform in the future. It means we will get less bold reform in the future. History tells this story from Truman through Obama. Only Democrats are this good at adopting Republican talking points when the going gets tough.
Nik Dixit: The way I see it:
A) This is still a great bill. Insurance regulations and subsidies are a huge win, and they will cover 30+ million people. Moreover, they establish the principle that government is responsible for ensuring coverage.
B) We can improve this bill later. Medicare and Social Securities each began as limited programs, but as they developed constituencies they became much more broad.
C) If we fail, we’re not going to get another chance for decades. When Truman/Nixon/Clinton failed, it was literally decades before anyone tried again (16 years in Clinton’s case). If this happens, literally hundreds of thousands of people will die in the interim.
It’s not a perfect bill, but it’s a good bill, and a bill that can be improved. We have the first real chance to do this in half a century, and we would be fools to toss it aside.
Jeremy Pilaar: I know this bill still has a lot of good in it, but do either of you feel like we’ve crossed a line somewhere on the amount of acceptable concessions we’ve been giving to get 60 votes? The political strategist in me says “yes, duh”, but the citizen in me is screaming “wtf happened?”. With this president and this strong a democratic presence in congress, it feels highly disappointing that we were unable to get any sort of public option (even a trigger) as part of the bill. I feel like the public option was in and of itself a fairly big concession and a low starting point from which to build forward, and was willing to accept its removal and replacement with the medicare buy-in, but now I feel like the bill carries just as many advantages (if not more) for insurance companies as it does for consumers. Their profits are now not only locked in, but increased as a result of the pool of new customers now waiting at the door with public money in hand. I know that there will be some degree of strict new oversight, but the lack of any public option whatsoever sets up absolutely no alternative to the status quo that has so desperately failed up until this point and gives us no reason to think will change all that dramatically considering the power the insurance lobbies have in Washington. I guess it’s the Canadian and French in me speaking (vive la révolution!), but I would have liked to see at least some form of public health service...
Nik Dixit: Yeah, it’s a win for insurance companies. However, I don’t particularly care about insurance companies, I care about the average person. At the end of the day, the average person stands to gain a lot, too.
Robbie Bruens: A couple of things to note about what has been said here. First, the bill expands Medicaid coverage considerably. Hopefully we’ll get the House expansion, which is even bigger than the Senate expansion. There’s also some major improvements to Medicare. So even though we might not get a new public health service, we’re going to get better public health services out of the programs that already exist. And the other thing is that this bill establishes the principle that the federal government has the responsibility to ensure that health care is available for everyone. You could view it as the creation of a new implicit public health program…and once this principle is established it will never go away. Then we can be free to tinker around the margins as far as public/private and profit/nonprofit etc.
And as far as the insurance companies go, yes it is a win for them to not have to compete with a Medicare buy-in or any sort of public option. But there are two complexities to this story.
First, the insurance companies wouldn’t have had much trouble with a opt-out public option that has no ability to use Medicare’s bargaining power advantage (this is the version of the public option Reid had thought could get through the Senate with 60 votes until Lieberfuck and Brainless Nelson threw fits). What this says to me is that it would be better to get a public option that’s integrated into Medicare (and thus has a bargaining advantage) through a reconciliation vote (only need 50 Senators) next year or in 2011, rather than a weak public option with 60 votes this year. Because a weak public option could actually hurt the case for public health care in the long run.
Second, I do not see insurance companies as stronger after this bill passes regardless of what happens to the public option. They are essentially on life support, because they serve no useful purpose except to enable to excess profits of Pharma, the device manufacturers and the private hospitals and doctor’s groups. This is the most frustrating thing about the progressive backlash against Lieberman. The health insurance companies couldn’t beat a public option on their own. It’s the other parts of the medical-industrial complex that really stand to benefit and they are the true killers of the public option.
Which bring me to a final point. What this process has revealed is the continuing need for lobbying reform and campaign finance reform, but almost more importantly, reform of the United States Senate. The filibuster has evolved into minority rule, and if we want to prevent the federal government from following California into the gutter, we need to help Senator Tom Harkin who is trying to change Senate procedure so they can actually function properly.
3 Responses to “A Socratic Dialogue on Senate Sausage Grinding”
Comment by Nik.
Dude, you should totally add a picture of Socrates in contemplation :p
Comment by Scott ffolliott.
Insurance Mandate to Buy Health Insurance for Individuals without the public plan or Medicare buy in:
It seems that the Senate has privatized the tax system so our taxes go directly to the health insurance companies.
By this fact, then can we privatize Medicare in the future and have payroll taxes go directly to insurance companies?
Comment by Pegah.
YESSS! So glad this was posted! Bravo, bravo, encore!