WASHINGTON — House Democrats approved a far-reaching overhaul of the nation’s health system on Sunday, voting over unanimous Republican opposition to provide medical coverage to tens of millions of uninsured Americans after an epic political battle that could define the differences between the parties for years.
With the 219-to-212 vote, the House gave final approval to legislation passed by the Senate on Christmas Eve. Thirty-four Democrats joined Republicans in voting against the bill. The vote sent the measure to President Obama, whose yearlong push for the legislation has been the centerpiece of his agenda and a test of his political power.
They then went on to approve a package of changes to the Senate’s bill. These changes had already been negotiated with Senate Democrats and are expected to pass quickly with a simple majority. I’m quite certain that President Obama will sign the bill into law once it’s passed the Senate.
I don’t know that any bill of comparably major importance has ever been passed on a strict party line vote with such ambiguous public support.
I’m not sure what’s in the final bill and I’m not sure that anybody else knows, either. As I’ve said before I strongly suspect that the pre-approved changes increase the cost of the Senate bill and decrease the already insufficient curve-bending measures in the bill, particularly the tax on so-called Cadillac healthcare insurance, the most direct cost control measure in the Senate bill.
Eza Klein seems confident that the cost control measures will persist. We’ll see. Most of the cost control depends on prudent action by future Congresses, never a good bet, and it should be remembered that controlling future Congresses is beyond Congress’s power.
Most of the those strongly in favor of the bill, like James Fallows, to my eye appear to like the idea of the bill rather than the bill itself.
I think it’s important to remember what this healthcare bill doesn’t do. It doesn’t treat any more people. To do that you’d need to have more healthcare than we do now and this bill does very little to expand the amount of healthcare that’s available. At most it spreads the existing healthcare around more equitably.
It doesn’t cause communities that are already underserved to be served better. That’s beyond the scope of this bill, something that really hasn’t been thought much about yet.
It doesn’t save any lives. Physicians are already ethically obligated to treat people without taking their ability to pay into consideration. Hospitals are legally required to provide emergency treatment without taking people’s ability to pay into consideration. If you believe that people are dying for lack of treatment, then you believe that physicians are acting unethically and hospitals are acting illegally, simple as that. Indeed, if the reductions in Medicare spending are actually enacted and physicians are acting unethically and hospitals are acting illegally, then more people may die.
It doesn’t reduce healthcare spending. Indeed, it increases total healthcare spending by roughly 10%.
It doesn’t bring healthcare costs down. It might in the future but that depends on a lengthy list of assumptions. It is possible that healthcare reform in this form will actually increase costs. When you throw more money at something where there’s a supply bottleneck, that can happen.
When the euphoria/doom and gloom has settled down, I hope that the people and the Congress recognize that we still need healthcare reform. It’s hard for me to imagine much stomach for it.