It is now virtually certain that the Senate will pass the health care reform bill currently before it. We must still suffer through the agonies of the Senate-House conference, but the odds are very great that sometime before his State of the Union address to the assembled members of Congress, the President wll sign a final bill, with as much in the way of bells and whistles, flourishes and furblows, as the White House staff can manage.
When this happens, it will be an enormous political victory for Obama, regardless of the details of the bill, and a terrible defeat for the Republicans. It did not have to be this way, of course. Had the Republicans accepted Obama's offer of bipartisanship, they could have won a bill much closer to what they say they are in favor of, and they would have shared the credit, going into the off-year elections.
But that is not what they wanted. No sooner had Obama taken the oath of office than Republicans began to say, openly and unashamedly, that their primary goal was to make Obama's presidency a failure. Gambling that at least one Democratic senator would break ranks, despite Harry Reid's best efforts, and, in all likelihood, privately hoping that Robert Byrd would expire before the final vote [a hope that devoutly Christian, born-again, but terminally stupid Tom Coburn actually gave voice to on the floor of the Senate], they dug in their heels, doubled down, bullied Olympia Snowe into behaving herself, and went for broke.
The victory, should it occur, will give Obama tremendous momentum going into 2010, just in time to throw his entire administration behind an effort to create jobs.
There is no evidence of which I am aware that the majority of Republicans care two cents about health care. Some of them are in the bag to the health industry lobbies, no doubt, but that is as true of the Democrats as of the Republicans. No one is more beholden to the health care insurance industry than Joe Lieberman, the "Senator from Hartord," as he is referred to, but even he, in the end, has gotten on board, after extracting some concessions for the industry that owns him.
If it comes to pass [he says, crossing the eight fingers with which he is not typing], it will be an extraordinary vindication for Obama's style of governing. And the Republiocans will have given it to him.
Historically, it has been conservatives, not radicals, who cherished ironies, but these days, one must get one's pleasures where one can.
Showing posts with label health care reform. Show all posts
Showing posts with label health care reform. Show all posts
Tuesday, 22 December 2009
Sunday, 20 December 2009
OLD TRUTHS REPEATED
As we close in on a Senate health care reform bill, Howard Dean and a number of other voices on the left have suddenly started calling for the bill to be defeated. Moveon.org has launched a campaign to attack the most liberal senators for failing to fight more vociferously for the public option. This is just madness, a petty pouting at the compromises that had to be made to overcome a Republican filibuster.
I have said this before, and I will say it again. If you are looking for a target for your anger, aim it at the drug companies, at the health care industry, or -- most appropriately -- at the American people. If they were willing to elect sixty Bernie Sanders and Russ Feinbergs, we would live in a socialist paradise. The liberals in the Senate have been fighting a rearguard action since they stepped onto the field of battle. Those forty Republican senators pretty accurately represent perhaps forty percent or more of the American people. Barack Obama won less than 53% of the popular vote. Almost 47% of those voting chose John McCain and Sarah Palin. That is the reality of the American political landscape. Obama positioned himself only moderately to the left of center on the issues, and still only pulled less than 53% of the vote. What is going on in the Senate right now is a complex, messy, infuriating, excruciating, but quite accurate reflection of that reality.
You want Bernie Sanders to call the tune? So do I. Fine. Don't hold protest meetings in Greenwich Village, or Cambridge, Mass, or Berkeley, California, or Hyde Park, Chicago. Hold them in Ogden, Utah or Charleston, South Carolina. Never been to Ogden or Charleston? Wouldn't go on a bet, because they are not your kind of people? Then stop complaining and take what you can get!
I have said this before, and I will say it again. If you are looking for a target for your anger, aim it at the drug companies, at the health care industry, or -- most appropriately -- at the American people. If they were willing to elect sixty Bernie Sanders and Russ Feinbergs, we would live in a socialist paradise. The liberals in the Senate have been fighting a rearguard action since they stepped onto the field of battle. Those forty Republican senators pretty accurately represent perhaps forty percent or more of the American people. Barack Obama won less than 53% of the popular vote. Almost 47% of those voting chose John McCain and Sarah Palin. That is the reality of the American political landscape. Obama positioned himself only moderately to the left of center on the issues, and still only pulled less than 53% of the vote. What is going on in the Senate right now is a complex, messy, infuriating, excruciating, but quite accurate reflection of that reality.
You want Bernie Sanders to call the tune? So do I. Fine. Don't hold protest meetings in Greenwich Village, or Cambridge, Mass, or Berkeley, California, or Hyde Park, Chicago. Hold them in Ogden, Utah or Charleston, South Carolina. Never been to Ogden or Charleston? Wouldn't go on a bet, because they are not your kind of people? Then stop complaining and take what you can get!
Friday, 18 December 2009
KRUGMAN AND HEALTH CARE REFORM
I am not an enormous fan of Paul Krugman, perhaps because he was an early and fervent supporter of Hillary Clinton in the presidential primary. But his column today in the NY TIMES on health care is exactly right. If I were technologically more sophisticated, I would put an link right here on which you could click, but you can simply go to http://www.nytimes.com and find his column on the front page. I recommend it.
Meanwhile, I am engaged in the far more important mission of locating somewhere that I can buy the one brand of cat food that Murray is willing to eat. Were I religious, I would conclude that God is testing me.
Meanwhile, I am engaged in the far more important mission of locating somewhere that I can buy the one brand of cat food that Murray is willing to eat. Were I religious, I would conclude that God is testing me.
Thursday, 10 December 2009
THE HEALTH CARE REFORM PROCESS, YET AGAIN
While Harry Reid and his Gang of Ten await the CBO scoring on the latest complex compromise proposal, it might be well to pause for a moment and reflect on how this enormously important debate has developed in the past eight months or more.
It was obvious to virtually everyone, when it began, that the process would be lengthy, contentious, tedious, complex, and fraught with political manoeuvres and dangers. Five House committees, two or three Senate committees, all debating a fundamental reorientation of one seventh of the entire American economy. Nothing this complex has been attempted in generations.
At the very beginning of the process, the Republicans made a decision. Since they are not stupid -- vicious, perhaps, despicable, undoubtedly, deeply in debt to special corporate interests, inevitably, but not stupid -- I assume the decision was conscious, calculated, deliberate, and much debated in Republican circles. The decision was to try to destroy the Obama presidency by doing everything in their power to defeat any attempt at health care reform, virtually regardless of its content. They knew that they could muster forty votes in the Senate, and it was quite unclear whether Harry Reid could hold a fractious coalition of fifty-eight Democrats and two Independents. [Remember that at this point, it was not yet clear whether Al Franken would prevail in his Senate contest].
So, despite the exhausting efforts of MaxBaucus to secure a bi-partisan coalition in his committee, the Republicans steadfastly voted against everything.
And the result? They have rendered themselves completely irrelevant to the process of negotiating a final bill. Despite their endless posturing on the floor of the Senate, despite the Tea Baggers and the disruptions in summer town hall meetings, they have completely closed themselves out of the crafting of the final bill. There is no doubt that, had they chosen to engage in genuine bi-partisan negotiations, they could have played an important role in writing the bill. But they chose instead to gamble on bringing Obama down.
Now, all of this is rather new even to folks like myself who are obsessed with politics. But it cannot have been at all new to the senior members of the Republican Senate caucus. They must have been quite well aware that their chosen strategy guaranteed them no input into the bill finally brought to a vote before the two houses of Congress. They were even willing to desert their corporate patrons, who may have been counting on them to make the final bill friendlier to corporate interests. Their lust for the kill, for destroying the Obama presidency in its first year, took precedence over everything else.
And so we have the spectacle, now, of intense negotiations being conducted entirely among -- Democrats. To be sure, corporate interests are hardly unrepresented in those closed meetings. But the absence of any Republicans at the table tilts the balance of forces markedly leftward of where it would have been otherwise.
Will the Republican gamble pay off? Will they, at the last moment, peel away Ben Nelson or Joe Lieberman or Evan Bayh or Mary Landrieu? I think it is clear that the answer is no. The momentum is so great now to pass something that the most those people can do is to push the bill marginally to the right.
Think what this will mean. First, it will be, and will be seen as, an enormous victory for Obama. Hence, the Republicans will have lost. Second, a wide variety of extremely important reforms and changes will have been enacted, whatever the final shape of the bill. Everyone has agreed to stop insurance companies from denying insurance to people with pre-existing conditions. Everyone has agreed that thirty million or more Americans now uninsured will become insured. There are countless other good things in the proposed legislation that are not even in dispute.
Fascinating.
It was obvious to virtually everyone, when it began, that the process would be lengthy, contentious, tedious, complex, and fraught with political manoeuvres and dangers. Five House committees, two or three Senate committees, all debating a fundamental reorientation of one seventh of the entire American economy. Nothing this complex has been attempted in generations.
At the very beginning of the process, the Republicans made a decision. Since they are not stupid -- vicious, perhaps, despicable, undoubtedly, deeply in debt to special corporate interests, inevitably, but not stupid -- I assume the decision was conscious, calculated, deliberate, and much debated in Republican circles. The decision was to try to destroy the Obama presidency by doing everything in their power to defeat any attempt at health care reform, virtually regardless of its content. They knew that they could muster forty votes in the Senate, and it was quite unclear whether Harry Reid could hold a fractious coalition of fifty-eight Democrats and two Independents. [Remember that at this point, it was not yet clear whether Al Franken would prevail in his Senate contest].
So, despite the exhausting efforts of MaxBaucus to secure a bi-partisan coalition in his committee, the Republicans steadfastly voted against everything.
And the result? They have rendered themselves completely irrelevant to the process of negotiating a final bill. Despite their endless posturing on the floor of the Senate, despite the Tea Baggers and the disruptions in summer town hall meetings, they have completely closed themselves out of the crafting of the final bill. There is no doubt that, had they chosen to engage in genuine bi-partisan negotiations, they could have played an important role in writing the bill. But they chose instead to gamble on bringing Obama down.
Now, all of this is rather new even to folks like myself who are obsessed with politics. But it cannot have been at all new to the senior members of the Republican Senate caucus. They must have been quite well aware that their chosen strategy guaranteed them no input into the bill finally brought to a vote before the two houses of Congress. They were even willing to desert their corporate patrons, who may have been counting on them to make the final bill friendlier to corporate interests. Their lust for the kill, for destroying the Obama presidency in its first year, took precedence over everything else.
And so we have the spectacle, now, of intense negotiations being conducted entirely among -- Democrats. To be sure, corporate interests are hardly unrepresented in those closed meetings. But the absence of any Republicans at the table tilts the balance of forces markedly leftward of where it would have been otherwise.
Will the Republican gamble pay off? Will they, at the last moment, peel away Ben Nelson or Joe Lieberman or Evan Bayh or Mary Landrieu? I think it is clear that the answer is no. The momentum is so great now to pass something that the most those people can do is to push the bill marginally to the right.
Think what this will mean. First, it will be, and will be seen as, an enormous victory for Obama. Hence, the Republicans will have lost. Second, a wide variety of extremely important reforms and changes will have been enacted, whatever the final shape of the bill. Everyone has agreed to stop insurance companies from denying insurance to people with pre-existing conditions. Everyone has agreed that thirty million or more Americans now uninsured will become insured. There are countless other good things in the proposed legislation that are not even in dispute.
Fascinating.
Wednesday, 9 December 2009
TWISTS AND TURNS IN HEALTH CARE REFORM
I think my blog posts have made it abundantly clear that I am not shy about offering opinions on a wide range of matters, about many of which I know virtually nothing. See, for example, my strong dissent from Obama's Afghanistan policy. But the latest turn in the health care reform story has me puzzled, and I welcome all the help I can get in understanding it.
As many of you will have heard, late yesterday a group of ten Democratic Senators convened by Harry Reid reached agreement on a totally new direction for health care reform. According to reports, which are fragmentary, the so-called public option will be scrapped or set aside, and instead several new components of reform will be introduced, most notably lowering the age for a Medicare buy-in to 55 for persons who are not now covered by health insurance.
My head snapped up when I read that, because it seemed to me that this was far and away the most revolutionary proposal with any serious hope of being adopted. But maybe I am wrong. This is where I need some guidance from those wiser and more knowledgeable than myself.
Let me explain. Since the end of World War II, the foundational premise of the American health care system has been that families will obtain health insurance through the employer of the family's principal wage earner, assumed to be the father of a two parent family. That assumption fit the facts for a large number of working class or middle class families whose principal wage earner worked in a large industrial firm [U. S. Steel, General Motors, etc.] or for a branch of state, local, or the federal government. Workers generally retired at age 65 [or earlier in industries with very strong unions], leaving all but the workers with the best union contracts without health care coverage in their senior years.
As the numbers of people living well beyond sixty-five soared, a crisis of poverty among the aged developed, and the government's response [fought bitterly by the Republicans, of course] was Medicare. The crisis of health care for the poor was met with the response of Medicaid.
Medicare is a single-payer government run health care insurance plan, and it is the foundation on which is built the relatively secure economic condition of the nation's very large number of senior citizens. My wife and I are now enrolled in Medicare, and I have a very good worm's eye view of how it works. When either of us needs medical attention, we go to the doctor or medical group of our choice [UNC or Duke Health, in our case, for the most part], present a Medicare card, and without co-pays or hassles, receive good care. We pay each month for Medicare Part B, the premium for which is deducted from our Social Secutiry checks, and through my former employer, I purchase a supplementary plan that covers, among other things, prescription drugs. The Federal Government sets the amounts that it will pay to reimburse medical care providers, and periodically I receive a form in the mail that shows how much the doctor or hospital charges for the service [usually an enormous amount], how much Medicare will pay [much, much less], and how much I owe [nothing, because, as the form says, the provider has agreed to accept the Medicare payment as full reimbursement for the service.]
The new proposal being hammered out opens Medicare to some people who are still of working age -- 55. Now, here is what has me astonished. This proposal, though at first it would affect a relatively small number of people, undermines the premise on which the entire American health care system is founded. Once those 55 to 64 whose employers do not offer health insurance are given the option of buying into Medicare, how long will it be before employers stop offering health insurance? How long will it be before there is a demand to lower the cost of the buy-in to the level now charged for seniors? How long will it be before the cry goes up to lower the age to 53, 50, 45?
Am I simply all wrong, or does this look like the first hesitant step toward a single payer national health care system? The insurance industry will of course fight it tooth and nail, because it is a death sentence for them. Republicans, if they have their wits about them, should go ballistic. But employers who see the possibility of shedding the burden of offering health insurance should love it.
I welcome comments. I am really mystified about this one.
As many of you will have heard, late yesterday a group of ten Democratic Senators convened by Harry Reid reached agreement on a totally new direction for health care reform. According to reports, which are fragmentary, the so-called public option will be scrapped or set aside, and instead several new components of reform will be introduced, most notably lowering the age for a Medicare buy-in to 55 for persons who are not now covered by health insurance.
My head snapped up when I read that, because it seemed to me that this was far and away the most revolutionary proposal with any serious hope of being adopted. But maybe I am wrong. This is where I need some guidance from those wiser and more knowledgeable than myself.
Let me explain. Since the end of World War II, the foundational premise of the American health care system has been that families will obtain health insurance through the employer of the family's principal wage earner, assumed to be the father of a two parent family. That assumption fit the facts for a large number of working class or middle class families whose principal wage earner worked in a large industrial firm [U. S. Steel, General Motors, etc.] or for a branch of state, local, or the federal government. Workers generally retired at age 65 [or earlier in industries with very strong unions], leaving all but the workers with the best union contracts without health care coverage in their senior years.
As the numbers of people living well beyond sixty-five soared, a crisis of poverty among the aged developed, and the government's response [fought bitterly by the Republicans, of course] was Medicare. The crisis of health care for the poor was met with the response of Medicaid.
Medicare is a single-payer government run health care insurance plan, and it is the foundation on which is built the relatively secure economic condition of the nation's very large number of senior citizens. My wife and I are now enrolled in Medicare, and I have a very good worm's eye view of how it works. When either of us needs medical attention, we go to the doctor or medical group of our choice [UNC or Duke Health, in our case, for the most part], present a Medicare card, and without co-pays or hassles, receive good care. We pay each month for Medicare Part B, the premium for which is deducted from our Social Secutiry checks, and through my former employer, I purchase a supplementary plan that covers, among other things, prescription drugs. The Federal Government sets the amounts that it will pay to reimburse medical care providers, and periodically I receive a form in the mail that shows how much the doctor or hospital charges for the service [usually an enormous amount], how much Medicare will pay [much, much less], and how much I owe [nothing, because, as the form says, the provider has agreed to accept the Medicare payment as full reimbursement for the service.]
The new proposal being hammered out opens Medicare to some people who are still of working age -- 55. Now, here is what has me astonished. This proposal, though at first it would affect a relatively small number of people, undermines the premise on which the entire American health care system is founded. Once those 55 to 64 whose employers do not offer health insurance are given the option of buying into Medicare, how long will it be before employers stop offering health insurance? How long will it be before there is a demand to lower the cost of the buy-in to the level now charged for seniors? How long will it be before the cry goes up to lower the age to 53, 50, 45?
Am I simply all wrong, or does this look like the first hesitant step toward a single payer national health care system? The insurance industry will of course fight it tooth and nail, because it is a death sentence for them. Republicans, if they have their wits about them, should go ballistic. But employers who see the possibility of shedding the burden of offering health insurance should love it.
I welcome comments. I am really mystified about this one.
Sunday, 8 November 2009
WELL, THAT'S HALF OF IT
Murray, the Shadkhan, was tired. [shadkhan -- Jewish marriage broker]. For three months, he had been trying to find a wife for Mrs. Shapiro's precious son, Bernard. The butcher's daughter? Not refined enough. The baker's daughter? Too fat. The moyle's daughter? Too dull. The rabbi's daughter? Not sufficiently devout. Truth be told, Bernard was no great catch, but in Mrs. Shapiro's eyes, he was a Prince of the Realm, and only the perfect girl would do. As he sat in his kitchen drinking tea from a glass and listening to reports of the elevation of Crown Princess Elizabeth to the English throne, a thought crossed Murray's mind. The Princess Margaret Rose was still single. Could this be the solution to his problem? To be sure, she wasn't Jewish, but she was rich as Croesus, and a princess to boot! He put on his hat and his best coat, and rushed off to talk to Mrs. Shapiro.
It was not easy. Was she pretty? Mrs. Shapiro wanted to know. As beautiful as Queen Nefertiti! Good manners? She is a PRINCESS, he protested. But she isn't Jewish. She'll convert, I'm sure of it. Murray was desperate, and even Mrs. Shapiro was growing restive. Finally, after one last rehearsal of her objections, reluctantly, she agreed to allow Bernard to marry the Princess Margaret Rose of England, but only if the wedding was held here in town so that her friends could come and burn with envy.
A great weight lifted from his shoulders, Murray put on his coat and hat and stepped out into the street. His eyes lifted heavenward, he said a silent prayer. Then, with a shrug, he pulled himself together, and said, aloud: "Well, that's half of it."
It was not easy. Was she pretty? Mrs. Shapiro wanted to know. As beautiful as Queen Nefertiti! Good manners? She is a PRINCESS, he protested. But she isn't Jewish. She'll convert, I'm sure of it. Murray was desperate, and even Mrs. Shapiro was growing restive. Finally, after one last rehearsal of her objections, reluctantly, she agreed to allow Bernard to marry the Princess Margaret Rose of England, but only if the wedding was held here in town so that her friends could come and burn with envy.
A great weight lifted from his shoulders, Murray put on his coat and hat and stepped out into the street. His eyes lifted heavenward, he said a silent prayer. Then, with a shrug, he pulled himself together, and said, aloud: "Well, that's half of it."
Saturday, 7 November 2009
THE REPUBLICANS ARE RIGHT
For what seems an eternity, I have been obsessed with the struggle to reform health care, following the death and resurrection of the public option, anguishing over Joe Lieberman's threatened defection, second guessing the strategy of the Obama White House. In the background has been the constant drumbeat of hysterical warnings from the Republicans that passage of the bill will destroy American democracy, ensconce Hitlerian policies in American law, and bring the Republic to an end.
Today, I have been spending a good deal of time watching the proceedings in the House of Representatives, listening to speakers from both sides echo talking points long since reduced to bumper sticker slogans. And slowly, very slowly, it has been dawning on me that the Republicans are right! This IS an historic bill. It WILL fundamentally change what goes on in the United States. It IS an expansion of the federal role in the life of the country surpassed perhaps only by the militarization of America over the past half century.
The Republicans are right to be desperately fearful. This bill, if something very like it can get through the Senate, will alter the lives of countless Americans, just as did Social Security and Medicare. And their united opposition to it will be an albatross around their necks for a long time to come. One of the many clauses in the bill stands out in my mind for its revolutionary impact: No longer will insurance companies be able to deny coverage for pre-existing conditions. That change alone is worth all the sturm und drang.
We have been waiting for this since I was in elementary school, sixty-five years ago, and now, it very much appears, it is going to happen. When we take the measure of Barack Obama's first year, let us remember to place this accomplishment in a place of honor.
Today, I have been spending a good deal of time watching the proceedings in the House of Representatives, listening to speakers from both sides echo talking points long since reduced to bumper sticker slogans. And slowly, very slowly, it has been dawning on me that the Republicans are right! This IS an historic bill. It WILL fundamentally change what goes on in the United States. It IS an expansion of the federal role in the life of the country surpassed perhaps only by the militarization of America over the past half century.
The Republicans are right to be desperately fearful. This bill, if something very like it can get through the Senate, will alter the lives of countless Americans, just as did Social Security and Medicare. And their united opposition to it will be an albatross around their necks for a long time to come. One of the many clauses in the bill stands out in my mind for its revolutionary impact: No longer will insurance companies be able to deny coverage for pre-existing conditions. That change alone is worth all the sturm und drang.
We have been waiting for this since I was in elementary school, sixty-five years ago, and now, it very much appears, it is going to happen. When we take the measure of Barack Obama's first year, let us remember to place this accomplishment in a place of honor.
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