The House of Representatives has passed its version of healthcare reform:
WASHINGTON — Handing President Obama a hard-fought victory, the House narrowly approved a sweeping overhaul of the nation’s health care system on Saturday night, advancing legislation that Democrats said could stand as their defining social policy achievement.
After a daylong clash with Republicans over what has been a Democratic goal for decades, lawmakers voted 220 to 215 to approve a plan that would cost $1.1 trillion over 10 years. Democrats said the legislation would provide overdue relief to Americans struggling to buy or hold on to health insurance.
“This is our moment to revolutionize health care in this country,†said Representative George Miller, Democrat of California and one of the chief architects of the bill.
Democrats were forced to make major concessions on insurance coverage for abortions to attract the final votes to secure passage, a wrenching compromise for the numerous abortion-rights advocates in their ranks.
Many of them hope to make changes to the amendment during negotiations with the Senate, which will now become the main battleground in the health care fight as Democrats there ready their own bill for what is likely to be extensive floor debate.
The bill that passed the House is ill-considered for political, governance, and fiscal reasons.
Consider the Social Security Act of 1965, the bill that established Medicare and Medicaid more than 40 years ago. Here’s the breakdown of the votes by which it passed:
|
Summary of Party Affiliation |
|||
| SENATE |
YEA |
NAY |
NOT |
| Democrats |
57 |
7 |
4 |
| Republicans |
13 |
17 |
2 |
| HOUSE |
YEA |
NAY |
NOT VOTING |
| Democrats |
237 |
48 |
8 |
| Republicans |
70 |
68 |
2 |
Note that it passed the House with a majority of Republicans voting for it as well as the preponderance of Democrats.
Clearly, this was a partisan result for both sides. Too many Republicans have taken a “just say no” approach to healthcare reform. Healthcare reform is vitally necessary. We can’t achieve anything resembling fiscal sanity without it. And too many Democrats have taken their Congressional majorities as a mandate to ride roughshod over their opponents.
However, representing only a faction within the Democratic Party, it is bad governance as well. The Congressmen who voted “Aye” don’t just represent the progressives in their districts or the Democrats in their districts, they represent all of the people in their districts and on that basis they have voted in accord with a minority of the American people.
Relying as this bill does on gimmicks and ruses is both bad governance and fiscally unsound. The CBO when grading this bill noted with some skepticism that its budget neutrality relied on something that the Congress has steadfastly refused to do: reduce the Medicare reimbursement rates to physicians and hospitals. There are already bills eliminating that move yet again making their way through the Congress which will strip that figleaf away, leaving this sorry excuse for healthcare reform in all its naked budget-busting glory.
And then there’s the effect this bill will have on already overburdened state budgets, something not even included in the CBO’s reckoning. Nobody knows what the final true total cost of this bill will be but it will almost certainly exceed $2 trillion over ten years.
Now its on to the Senate where passing the Senate’s version of healthcare using procedural means by a narrow majority just like the House bill is already being discussed.
I would have preferred a true single-payer system, a British-style national healthcare system, or even significantly more conservative approaches to the House bill.
It is not as though a more sound approach were not available. The House rejected Wyden-Bennett in committee.
I’m surprised Pelosi pushed the vote threw with 15% of her caucus opposed. It seems to send poor singaling to the Senate.
My read of the situation is that Pelosi didn’t think she could get a better bill past her more firebrand ideologues (she may be one of her more firebrand ideologues for all I know) and wanted to get something passed desperately.
If a bill passes, it was brilliant generalship. If no bill passes, it was stupid.
Me too, but you’ve got to start somewhere. Social Security originally was exclusive on racial and gender lines (specifically including a whole bunch of professions that just happened to be dominated by women and blacks), but it was improved over time (not in the sense of cost control, although Reagan did what we probably ought to consider doing now – raising the age limit again).
Just a question on costs. Ever wonder why we dont have a WalMart in health care? We do have institutions like Kaiser that work across state lines and they are cheaper, but they arent exactly taking off. There really seems like there would be a market for lower cost care, but you just do not see anything taking up that niche. Hard to blame it all on insurance since co-pays and deductibles are so high now. HSAs are becoming a little more common. Still, no chain of reliable low cost care. Some place with plain facilities and no frills care.
My own experience both with my group and our hospital is that having low costs made no difference. It looks to me as though the consumers largely, in the aggregate, ignore costs.
Steve
Of course they ignore the costs. By and large the consumers don’t bear the costs.
What are your deductibles? Ask around and find out what others have?
Steve
The only costs most consumers are aware of and care about are premium costs, copays, etc.
My neighbor’s son (2 years old) had liver cancer which metastasized. He did get a liver transplant, is doing well, but is on two years of Chemo. His hospital bill was $190k of which insurance (military – tricare) paid $130k. They were amazed at some of the things that were charged for. There was $1600 a day for physical therapy during his stay at the hospital, even though the therapy only took place about 1/2 the days. The therapists came everyday, but many days he was sleeping or feeling ill, so no therapy occurred. So tricare paid $1600 for someone to walk into his room and walk right back out. The bill had a lot of stuff like that. My neighbors did not have a clue about any of this until they got breakdown almost a year later and it’s not like they have any incentive to dispute any of the items. This is the kind of thing that happens when consumers are almost completely insulated from what they are buying.
Heaven knows we need more transparency in costs, but let us look at your example. Lots of large companies are self-insured. If your neighbor works for a small business, that company faces a major increase in costs. I would think that both the small business and the large self insuring companies would love to have the option of a low cost, no frills provider. Most people do not pay the bulk of their insurance costs, but their employers do.
Steve
Very depressing, but in talking to some of my co-workers I’m not surprised. The level of ignorance surround health care is simply staggering. One thought it was nothing other than insuring the uninsured. When I pointed out that the current system is wholely unsustainable and likened it to him having income growth of 3%/year but an expense growing at 6%/year he saw my point (he maybe ignorant, but not stupid). When I made the comment that insurance shouldn’t cover pregnancy the statement was met with shock and derision. When I asked what is the definition of insurance they couldn’t really tell me, when I said it is to protect agains LARGE and UNEXPECTED costs they got it right way…pregnancy is not unexpected.
My guess is Robert Higgs is right. We will just keep digging the fiscal hole to the point where it eventually caves in on us. Any attempt to stop it will either go nowhere or end very badly (these are people that have both power and are exceedingly well armed). Its all very depressing.
Steve,
Actually, pregnancy is frequently unexpected, but your other points are well taken.
Interesting…the conversation above, perhaps we’ll see more of this later once the health care bill is signed into law. There are lots of problems with the health care system as it is…it may be that the passing of health care reform will force us as a nation to realistically begin to take a serious look at the system as a whole and begin to make the corrections as we move forward, which in the end, may actually reduce health cost…no actual therapy, no fee and so on…
Our national safety net (Medicare and Social Security) are tens of trillions of dollars in imbalance. We’ll need substantial tax increases just to cover those costs alone….and there is no “serious looks” being taken at either of those systems. No, this is just wishful thinking.
The history of healthcare reform in the United States is that we take what passes for a serious crack at it roughly every fifteen years. There will be no immediate revisiting of healthcare. There will be no appetite for fine tuning what’s been passed let alone tossing it out and starting over.
Considering the way things have been going for the last three or so decades, we might be in for a major shift in how things are done..on the subject Social Security and Medicare, there are diverse views on the actual solvency, not all are as bleak as some would like us to think.
There is the cost of the wars, we could cover the health care, sure up medicare and get realistic with social security and save lives by ending that mess.
We could reinstate the massive tax cuts given to those who actually need them the least and and get rid of the corporate welfare system. We could go on…there is plenty of funds available to pay for health care, social security and medicare, we just need to decide how we want our tax dollars spent, on guns and bombs, or on people.
Larry,
Health care costs are rising at 2-3 times inflation and/or GDP. There is no revenue stream that is sustainable while that condition exists.
Look at military spending, which is about 5-6% of GDP currently. Health care is about 16% of GDP and is expected to hit around 21 or 22% in ten years. What the means is that if all defense spending was put into health care tomorrow we’d be right back where we are today in a decade. That’s what happens when costs rise faster than growth, income or revenue.
To build on what Andy just wrote. Once you absorb the macro-numbers of the size of our healthcare costs and their growth rate, it becomes extremely troubling as Congress looks to requiring states and employers to take on that responsibility. Most of us do not work in jobs in which we are over 10% more productive year after year. Most states cannot afford that obligation either. I don’t like the idea of a single-payer system because I think America is too large, its social structure too unwieldy, but I get what Dave says about it being better than what might be emerging. I fear many employers and states will crack under the load.
With this statement, Steve Verdon (November 8, 2009 at 10:08 pm) hits his first decision point:
This decision node tells us that government has no role in delivering health care to women, and neither does Medical Health Insurance.
I will pick Sweden as the gold standard on this issue. With a well coordinated government social/medical service aimed at ensuring excellence in care for pregnant women and their children, they can claim the following: lower abortion rate, lower teen pregnancy rate, lower number of premature births, lower infant mortality, and ultimately because children are viewed as the future of society, among the lowest child poverty rates in the world.
By denying that neither government nor medical insurance has any role during pregnancy and the post partum child development Steve Verdon has thrown our children on the scrap heap of History. As a resident of the Shining City on the Hill, brother Steve has no need to examine any system that produces better results. After all, the US of A is Number 1#.
We’ve spent how much so far on the the two wars, to include all those private contractors we’ve hired to support our troops, 100 billion a year or more? The actual cost of these two wars may never be known..and this cost is above and beyond the military budget.
What is the cost of 36 million or more uninsured Americans? Who pays that bill?
If the GDP of health care is growing, where is it growing more specifically, can you break this down for me?
There is an interesting blog at http://www.thehealthcareblog.com/
If our information about the health care system is weak, then how do we really know what the true cost of quality health care will be..
“if that new, huge investment doesn’t generate the meaningful information to help us out of these fairly terrifying problems—that is, help us understand and target the persistent quality and exploding cost problems.
Unfortunately, we do not yet have that information. We don’t. We’re getting better, but we don’t have ideal measures or ways of reporting those measures to the people who need them. And by “peopleâ€, I mean the health professionals, and, well, us—the public. We are, however, getting much, much better at understanding what we need to do to create that great information.
So, we’re at an important point on our journey. Widespread, meaningfully applied health information technology could be the necessary accelerator for quality measurement and reporting—or at least we all hope it will. As we highlight in our report, we will know soon enough if this combination of hope, urgent need, innovation and technology will be the spark we need. If it is—if that happens—then in the next few years we will look back at this moment as the beginning of that acceleration. Like I now remember where I was when I first heard, “ONCHITâ€, we’ll remember 2009 as that moment when widely available, helpful public information about health care cost and quality really began to move health care from fragmentation and dysfunction onto a path of sustainable high value. Just in case, you might want to look around and remember since your kids or grandkids in a few years may ask, “Where were you?†”
I say we move forward….and I hope health care reform passes this year..we can tweak it as we go.
On some other post here I asked the question, the health insurance industry, without doubt, has piles of research, numbers stats, and who knows what other data bases they have compiled, where is that information, has anyone see it, do they talk about it, do they share this with the public, congress?
Baloney. I’d love to see reputable work that says the situation is not bleak.
You are not correct. How much have we spent on our wars? $30 trillion? $15 trillion? Don’t think so. Even if we take a really optimistic view of Social Security we are looking at at least $4-5 trillion imbalance. Possibly fixable. Medicare…lets be nice and lowball that problem at $30 trillion. And what is going to be the cost of health care reform? The $1.1 to $1.2 trillion we are seeing is likely going to be too low, and when we consider such a program over a longer time horizion it just makes the long term fiscal outlook even worse. The idea that if we stopped the wars and spent the money on Medicare and health care we’d solve the problem is just not based on any realistic analysis.
And once we bring home all those men and women from Iraq and Afghanistan and make them unemployed (remember we are going to be spending their pay on health care and Medicare) that is probably going to exacerbate the economic situation. And what a nice kick in the ass for those service people: “Hi, you risked your lives, and now you have no income. Have a nice day.” Sorry, just not going to happen.
Okay, lets say $1.5 trillion. You are off by about a factor of 30 to 40. No, really.
Paul,
Please stop distorting what I said and being such a dishonest ass. I didn’t say anything even close to,
Are you really telling us that women only have small and/or expected medical incidents?
Nice post hoc ergo propter hoc reasoning. Yes, becuase of stellar health care abortion, teen pregnancy and child poverty are all simply a function of health care and the mode by which it is delivered. Nothing like cultural views, income redistribution programs, and even possibly ethnic composition of the population play absolutely no role whatsoever. Must be nice to live in a univariate world.
You are a liar. I was pointing out that child birth is not an insurable event. That an insurable event is one that is both large and unexpected. Your view is that we should mandate insurance at a demolition derby and then experss shock when the premiums sky rocket. I didn’t say that because of this that there is no role for government in providing care for child birth. Problem is if you subsidize something you get more of it, not less. And when one is looking at trying to control the growth in costs that should be a consideration.
And yet another lie by “brother” Paul. I’d like to see you post a link, quote or anything supporting this claim. The problem for you is not only will you not be able to find such support, you will likely find statements that are almost the exact opposite. That the U.S. has the biggest problems regarding health care. Are costs are higher, are some of the fastest growing costs, and that the system often fails to deliver adequate care.
Really Paul, your sniping and lies and ignorance are becoming rather tiresome.