On a straight party line vote, the Senate has passed its version of healthcare reform:
WASHINGTON — The Senate voted Thursday to reinvent the nation’s health care system, passing a bill to guarantee access to health insurance for tens of millions of Americans and to rein in health costs as proposed by President Obama.
The 60-to-39 party-line vote, on the 25th straight day of debate on the legislation, brings Democrats a step closer to a goal they have pursued for decades. It clears the way for negotiations with the House, which passed a broadly similar bill last month by a vote of 220 to 215.
If the two chambers can strike a deal, as seems likely, the resulting product would vastly expand the role and responsibilities of the federal government. It would, as lawmakers said repeatedly in the debate, touch the lives of nearly all Americans.
I can only foresee a handle of possible scenarios. The House and Senate versions of healthcare reform are significantly different. Recently the White House has been touting their similarities but that’s fatuous. The DNA of a whale and a mouse have 92% in common. It’s the differences that make all the difference as fragile as the Senate bill is, the Senate and House bills will be hard to reconcile.
The House could swallow its indignation and accept the Senate bill lock, stock, and barrel as Mickey Kaus has been suggesting will happen for some time. That will infuriate the leadership of some unions since their membership hold some of the ”Cadillac plans” that the Senate bill plans to tax. House members are more vulnerable to pressure from their union constituents than Senators are so things are likely to look somewhat difficult to them. While accepting the Senate bill might enable a final bill to be passed, it might also lose the Democrats the House. While a lot do not all Democratic Congressmen have safe seats.
Speaking of him, Mickey Kaus is apparently seeing the reality of the Senate bill more clearly now:
Does the CBO analysis of the Senate health bill –the one that shows a 10-year deficit reduction of $132 billion–really assume that the scheduled reduction in doctor’s payments of 21 % will actually go into effect- even though everyone knows Congress plans a “doctors’ fix” to sharply reduce the cut, if not eliminate it entirely, in separate legislation. That’s what Reason’s Peter Suderman alleges, and it appears that he’s right. (See pages 13 and 18 of the CBO’s report.)
I originally assumed this omission wasn’t a major flaw, since the CBO was comparing a baseline in which doctor’s fees were cut 21% with a health care reform in which they were also cut by 21%. A “doctors’ fix” is going to happen, but the question was whether health care reform will make things better or worse apart from that “fix”–or from anything else, like an expensive new jet fighter, that could increase the federal budget. The “fix” could safely be ignored and treated as a separate issue.
But the more you think about it, the more the issues aren’t separable. What if the docs get their “fix,” their rates stay the same or rise, and this somehow affects the whole Medicare cost structure–indeed the whole medical cost structure–in ways that make the Senate bill relatively more expensive than the status quo (for example, by inflating the cost of all the free health care that would be provided under Medicaid, and the cost of all the extra health care that would be sought by newly insured Americans?)
Don’t blame the Congressional Budget Office for this. It’s their job to evaluate the prospective consequences of bills not to evaluate the likely or even inevitable behavior of senators.
This budget-busting doesn’t seem to bother Mickey particularly; I can only conclude that he subscribes to the “roomful of money” hypothesis.
As I’ve written repeatedly here before, I think the House and Senate bills, since they don’t face the problems of rising healthcare costs squarely, are likely to cause healthcare costs to rise faster than they otherwise would. Communities that are currently underserved will be served even less; healthcare costs will rise worldwide. Rather than enabling more people to receive healthcare, they’ll perversely cause fewer people to receive healthcare.
Good intentions are simply not enough. What you actually do matters, too.
