What a difference having the president in the country makes.
After a tumultuous and uneven week last week this week has been a major perhaps historic step forward on healthcare reform.
Two bills have advanced this week to the general assembly in each chamber of Congress. The three committees working on healthcare reform have joined together to forward a bill for markup to the floor of the House. While the Senate HELP committee in somewhat of a surprised outflanked the Fiance committee and passed a bill on a 13-10 partisan vote.
President Obama has certainly employed a full press at a crucial time in this healthcare battle. The president’s major push this week included meetings with members of both chambers of Congress, meeting with citizens and doing several interviews and announcements in the media. Republicans and conservative Democrats are pushing back but this has escalated from a mere skirmish to an all out war this last week. The biggest development has been the presidents departure from a bipartisan approach to cramming the bill through with just the support of his party though he met with Senator Snowe (R-NH) and Senator Collins (R-NH) to see if they have any interest in signing onto Democratic efforts.
The president is even taking on his own party with recent ads to get healthcare reform passed.
To simplify analyzes, both the House and Senate bills will be graded concurrently with proper denotation of notable disparities.
There are a few outstanding components of these healthcare reform bills.
“A” -Fully funding and expansion of access to Medicaid is a great relief for thousands of working poor. For many years Medicaid standards have left too many people who need healthcare and do not have enough income to purchase healthcare out of the loop.
“A” -Subsidies are very generous and supplied to families making up to 400% of the poverty level. That is subsidies for families who make a little over $88,000/year. This would be an “A+” save for the fact that the Senate bill has subsidies for families making up to 300% of the poverty level so this will need to be reconciled.
“A-” -The basic level of care spelled out in the healthcare reform bills are beyond basic and are quite robust with things like caps on out of pocket expenses and wellness care. It does not look like anyone with the new plans will be under insured like millions of Americans are with their current private insurance.
“BBB” Rating for Bye Bye Bipartisanship.
The healthcare bills have progressives fingerprints all over it from a strong (while delayed) public option to increasing in the progressive tax code. The healthcare reform bills hit on all cylinders of the presidents priorities being choice, reducing costs and increasing care. However, the House bill is stronger than the Senate bill as expected.
“B+” -CBO estimates that the healthcare reform plans will cost a little over $1 trillion dollars over 10 years (Republicans and the right wing echo chamber are already lying calling it $1.5 trillion) and $600 billion over 10 years, respectively. The CBO target is well within reach especially considering half of the cost can be recouped by cutting Medicare costs.
“B+” -The public plan once it kicks in both bills have a definitive public option.
“B” -Choice is a major part of both healthcare plans. The positive aspect of delaying the public plan is that people who have health insurance now will see minimal impacts, save for lower costs. A healthcare exchange will be established and a public plan will be part of that choice.
“B” -A little over half of the costs for the new healthcare plans will be paid for with taxing the wealthy in the House bill. Those making more $350,000/year and more will pay 5.4% more in taxes. While this will affect only 1.2% of the population it is far overdue to offset the huge break people who make over $115,000 get with the insanely low ceiling on the payroll taxes. This tax increase faces a steeper climb in the Senate Finance committee because of the conservative Democrats on that committee.
“B” -Private healthcare insurers will be regulated. Not talked about much but this is very important because to establish raise healthcare standards in this country healthcare reform not only needs to be universal but uniform. Private insurers and the public plan will have to adhere to uniform levels of coverage where these standards need to be established but the minimum requirements for both the public and the private plans with caps on out of pocket expenses is a major start listed above.
“B” -In the Senate bill payments to primary care providers (PCPs) will rise. Payments to other providers will not be cut across the board. This is a good part of the Senate bill because of the way private insurance companies squeeze PCPs now too many med students chose to specialize when many more PCPs are desperately needed. One purpose of universal healthcare is to promote preventative medicine and the only way to do that is for people to have regular medical checkups which will obviously required an influx of PCPs.
“B” -Where the two bills have a significant split is on cutting provider costs. The House bill will reimburse providers at or close to Medicare rates which will provide the greates cost savings of the two bills for the public plan.
“B” -There is shared sacrifice in the mandates in these bills as well. Large employers will have to offer coverage to all it’s employees and contribute 4% more in payroll taxes per employee based on the House plan. Coverage is mandated for individuals who can afford it. Government has to do it’s part to cut fraud and wast especially with Medicare and the new public plan.
“C” is for Compromises and Cutting Costs not up to the level of single payer.
There were obviously compromises in the bill. Senator Dodd (D-CT) pointed out that there was 160 Republican amendments in the bill. It is doubtful that those amendments made the bill stronger and were most likely put in there as political cover for conservative Democrats. Evaluating costs reductions you must evaluate these bills to the lowest cost alternative which is a single payer system.
“C+” -One of the major compromises is that even after a delay this is still virtual universal healthcare. 97% of Americans will be covered but many will opt out because it will be cheaper to take that risk and pay the penalty. For a 2.5% penalty on income mostly young healthy people will take their chances and opt out of the program. The more that opt out the more expensive insurance will be for everyone else like it is today with the uninsured. Because some percentage of people that do take the risk and opt out of the system will get sick or injured and not be able to pay for the care themselves. Also this 97% does not include undocumented immigrants who will raise healthcare costs for the rest of the population.
“C” -Cutting Medicare is necessary but the over $500 billion dollars of cuts expected over the next 10 years if not conducted properly could hurt struggling not for profit hospitals that take many Medicare patients. Some of this is offset by fully funding Medicaid where not for profit hospitals and clinics get many of their patients. There is waste and fraud in Medicare especially but if too much is summary cut it is like taking a hand saw to the problem rather than a scalpel.
“C” -Cutting provider costs in the House bill public plan goes deeper (near Medicare rates) than the Senate bill making the House bill the cheaper and stronger public option in that regard. Again this is something that would have to be reconciled depending on what bills pass.
“D” if for Delays and conservative Democrat Dunces.
“D” -The delay in the bills, especially outlined in the House bill are excessive because the best parts of the bill including the public plan and health insurance exchange do not kick in for four years. There are some practical reason for some delay but it should be much closer to 1-2 years than 4 years. It will take some time to develop and implement the plans with input from Congress and implementation with the Administration. No one expected this level of modification to our system to happen overnight but 4 years is too long.
“D” -One inherent weakness in the public option has always been the unintended but prognosticated effect that private insurance companies through businesses gaming the system will be able to cherry pick healthy people leaving most sick people in the public system. This would result in higher costs for the government. The delay actually helps a little here but there still has not been an adequate answer to prevent this from occurring.
“D” -The conservative Democrat dunces like Senator Baucus (D-SD) and Senator Nelson (D-NE) that still want to gum up the works. The HELP committees bill is incomplete because it’s up to Baucus’ Finance committee to approve ways to raise revenue to pay for healthcare reform. The longer they drag their feet the momentum that has been gained can dissipate. As Ezra Klein points out in his article some delay is necessary to keep employers from dumping costs by letting private insurance companies cherry pick healthy customers leaving all others for a public plan. Amendments to the bill in the “Free Choice Act” proposed by Senator Wyden (D-OR) may be a good way to mitigate this effect.
“D-” -Or I should say DINO- minuse with Senator Nelson (D-NE) might as well have read the right wing playbook on this quote. “Tax is a four-letter word” with voters, said Sen. Ben Nelson (D-Neb.). Even families not ranking in the top 1 percent of earners “hope they’re going to be there someday,” he said. “So they don’t necessarily think it’s fair.”
“F” Troop a.k.a The Grand Obstructionist Party.
As expected even though their are 160 amendments in the healthcare bill added by Republicans they are claiming they were part of the process.
“F” -Fearmongering continues based on Republican comments about both bills. Following are a few quotes by the party of NO:
“This supposed health care fix is a health care failure and a disaster for the American people,” Sen. Judd Gregg, R-N.H., said. “We still have time to turn this process around instead of steamrolling our country into a sub-par government-run plan, but it will require serious action from Democrats and Republicans and a pledge to put politics aside.”
“You can’t tax the job creators and expect them to create jobs,” said House Minority Leader John A. Boehner (Ohio)
Rep. Boener goes as far to parrot Frank Lutz notorious anti-healthcare reform memo.
Rep. John Boehner: “The forthcoming plan from Democratic leaders will make health care more expensive, limit treatments, ration care, and put bureaucrats in charge of medical decisions rather than patients and doctors. That amounts to a government takeover of health care, and it will hurt, rather than help, middle-class families across our country.”
Midterm Grade “B-” The bills would earn a solid “B” but the delays bring it down half a notch.
Of course what bills finally pass if any and are reconciled is yet to be determined.
So far the bills have got the mixed reviews expected with more progressive sources lauding the bill and conservative sources claiming it is the start of Armageddon. The disingenuous and intellectually dishonest right wing reviews are omitted on purpose.
For the reading challenged right wing the GOP has revisited it’s infamous healthcare bureaucracy chart. But in response “The New Republic” has released a chart of our current failed healthcare system.
Make no mistakes universal healthcare reform has advanced further than it ever has before but the battles are far from over.