When you have two points, you can draw a line, and this line goes straight through the utter failure of these behind-the-scenes negotiations to point squarely at the failure of the system, or, more accurately, the failure of the leadership to make the system work the way it is supposed to.
While the House managed to do what the Constitution and 200 years of precedent more or less says it should do—drafting, marking, and voting out bills in three separate committees, then negotiating a merged bill between the committee chairs and leadership to bring to a vote on the floor—the Senate makes us sit through all the trappings of this democratic process (for months and months), only to junk any and all that was accomplished for a backroom deal that never gains consensus because there was never a process designed to create buy-in. Beyond all the senators left out of the smoke-filled room, the fact that Lieberman, who was supposed to be one of the ten negotiating what would be the manager’s amendment, never showed for the meetings (having to eventually be replaced by Tom Carper) should have told any who were watching—most certainly Harry Reid—that Joe planned to screw them. Joe was not in the room, so Joe could always complain, object, and withhold his vote.
With Joe wholly and predictably untrustworthy, with Ben Nelson forever adding another prerequisite to his cloture vote (anti-abortion language, anti-public option language, anti-anti-trust language, and probably more in his quiver), and with the GOP solidly set on killing the bill (no, the pains from Maine will not vote with the Dems—I will put money on it), there is no magical “60-vote majority.” There is a 58-vote majority, or if you wanted to go all-in on a robust PO, maybe a 53-vote majority, but either way, the word “majority” still applies. (Jane, Jon, Kagro and others all can do and have done a better job at explaining how you get a perfectly sound reform bill out of the Senate without Miss Sixty.)
But what if the Senate, either through Faustian compromise, reconciliation, or nuclear option, votes out a bill that is something much, much less that what we (and by “we,” I mean something like 70% of Americans) would call meaningful health care reform? Dare we let the something less than perfect but still preferred be the enemy of the maybe not good but better than what we now have?
It is quite possible that the Senate will produce a bill that contains no public option—or, likely, a mythical and weak PO resting behind a trigger well-nigh impossible to pull—no ban on annual or lifetime caps, no repeal of the insurance anti-trust exemption, no pharmaceutical reimportation, and no real Medicare buy-in (and let me add no community rating and a meaningless loss ratio), all accompanied by an easy opt-out, and a time-lag on any benefits that could be as much as four years. It is also likely the bill will still include an individual mandate, a massive extension on patent protection for biologics, permission to sell national plans, and all the garbage that has been tossed in along the way (like money for abstinence-only education and start-up/conversion funds for state-based cooperatives). And (and I admit I am saying this without any evidence but a gut feeling), I fully expect that, when the smoke clears, we will discover loopholes in the bans on the exclusion of pre-existing conditions and rescission. With all of that, what do we have?
Well, we do have conference, and, as we have said all along, our leverage is with the House, with the Progressive Caucus, and with individual representatives; so, of course, we hold our allies to their commitments to a robust public, and hope that they demand whatever comes out of conference include one (and include one without triggers). But what if what comes out of that meeting between Pelosi and Reid (with a soupcon Emanuel and Obama thrown in) is something much closer to the Senate beast I outlined above? Then what?
You will find no more staunch advocate for helping people when the opportunity is given. I do not believe in destroying the hamlet in order to save it. Philosophical arguments don’t impress when forced to stand next to real suffering. I do not believe the revolution is just a kiss-off away. But if the final health care reform act resembles what I describe above (quite possibly with some not-quite-but-damn-near Stupak language further restricting access to abortion), I say: Kill the bill.
I say this with a heavy heart. Failure to pass health care legislation, even terrible legislation, will be a great loss for the Obama administration and for Democrats in Congress. But passing a bill as bad as the Senate’s eventual endpoint could be a bigger defeat for the Democratic majority we really want—one that takes progressive action on behalf of the voters.
Because, as I see it, a bill without the competitive force of a public option, or the opportunity for millions to buy into Medicare, without cheaper pharmaceuticals or meaningful controls on premiums, without bans on benefit caps or loophole-free safeguards against rescission, but with an individual mandate, will do nothing for the 30 million uninsured that advocates of the bill like to talk about helping—but it will do plenty for the private insurance and pharmaceutical industries.
For with a law something like what I’ve talked about here, insurance companies will be happy to sell plans of all stripes, from junk to Cadillac, to those who, for the most part, don’t need insurance—the young, well off, and healthy—while they will continue to victimize older, poorer, sicker Americans, either by handing them high-deductible, low-coverage, junk insurance, or by capping their benefits, or by finding ways to force them off their books altogether. This sort of “reform,” while technically insuring more Americans than the current system, won’t actually help many more of them.
I am even skeptical of any expansion of Medicaid (and skeptical that any will even make it into the final bill). If, by the luck of the draw, Medicaid eligibility goes up to 150% of the Federal Poverty Line, who’s to say that the funding to the states will be there. All one needs is a bad day of econometrics and a few “deficit hawks,” and you will see the expansion turn into another unfunded mandate—with many states passing the shortfalls right onto the indigent recipients in the form of service and eligibility cutbacks.
Further, with the lack of cost controls in the bill, the lack of the competitive force of a public plan, the lack of real negotiating power being granted to the federal government, the price of insurance, of drugs, and of healthcare in general will continue to soar. I, myself, carry individual insurance bought as part of a small, private group. I have seen my premiums almost double in five years. Just last year, one of noteworthy economic turmoil, my premium went up over 14%. Looking at the Senate version of the bill as described here, I do not see that trend reversing, or even slowing.
For American business, it will, as has been described by many, become harder to compete with countries that cover the healthcare of their workforce. Though President Obama has done far less than he should to stimulate employment in this gruesome economy, he is not wrong when he says that health care reform is, itself, a jobs bill.
But not this reform. This reform is a monopoly-building, jobs-busting bill. For, with an individual mandate, but little cost control and weak insurance regulation, Americans’ health care will not improve, but the bottom lines of AHIP and PhRMA will. Some of the money will come directly out of consumer pockets, some will come from government subsidies, but all will go straight to private, monopolistic, for-profit concerns.
And those heftier profits won’t just go to stock dividends and CEO bonuses, either (though a nice fat sum of it will). With increased resources comes increased lobbying, and increased campaign contributions, and increased advertising. So, if you think these concerns have a grip on the system now, if you think getting real reform passed is hard now, if you think the market is too consolidated now, and these private concerns are too big for the government to effectively control now, well, as that famous single-payer advocate Jimmy Durante* once said, “You ain’t seen nothing yet.”
So, if this is what health care reform comes to look like, then kill it and kill it we must. Killing it will not magically bring about a mass uprising of Senators and Representatives all pushing for single-payer-style reform, nor will it automatically cause an incensed populace to organize around the issue—that, in truth, could be a harder fight than this apparently Sisyphean struggle has been—but it will prevent Joe Lieberman or Ben Nelson from writing health care “reform,” and it will prevent entrenched powers from becoming even more entrenched.
*In truth I have no idea what position The Schnoz took on health care.
[UPDATE: Dave has more on Holy Joe.]