What You Need To Know: A Summary For You Lazy Asses
· The Left has been having a civil war over the Senate health care bill, between those who say it’s the best we can get and just accept it, and those who say that it’s too bad to be passed and we need to replace it. Also involved is the debate between those who say that government should provide services directly and those who say that government should provide services by reforming and regulating existing private entities.
· I’m usually in the “let’s try to get something better” and “government should provide services directly” crowd, so I would be expected to be in the group calling for the Senate bill’s demise. But I’ve actually been conflicted, because the pass-the-bill people have been using compelling emotional arguments about how people’s lives and health are on the line.
· However, their arguments have failed to convince me. I’ve said before that having an individual mandate but no public option is unconscionable, and I’m sticking by that. And no one has convinced me that this bill is significantly different on the merits from the 2003 Medicare prescription drug benefit law, which I (and many liberals who are now for the Senate bill) opposed.
· So, I’ve decided that while I would’ve voted to advance the bill out of the Senate, if the final, post-conference bill came back and had an individual mandate but no public option, I would have voted No, both on cloture and passage.
· If the Senate reconciliation sidecar proposal now being discussed has no public option, I would vote No. If it does have one, I would vote Yes.
· I would also be favorable to stand-alone bills to expand government insurance programs or create a government catastrophic insurance program.
· Scroll to the bottom to see a complete list of how I would vote on all the different versions of health care legislation.
The Left has been having a civil war for the past month over the Senate health care bill, which, because of the huge leverage Senators like Joe Lieberman and Ben Nelson had over the process, was essentially the final bill. On one side were those who agreed that the bill was far from perfect, but was a fairly good deal and the best we could get in the near future, and so we should just pass it. Matt Yglesias, Nate Silver, Ezra Klein, Jacob Hacker and, most notably, Paul Krugman, whom I normally think is spot-on about everything, were in this camp (with Krugman going so far as to compare the Senate bill to a simulation of single payer).
On the other side, you have those who say that the Lieberman-induced death of the public option, along with other troubling provisions like the excise tax on high-end insurance plans, make the Senate bill too bad to be passed. This group was a slightly less distinguished, motley array of liberal bloggers like Jane Hamsher and others at FireDogLake, David Sirota, Darcy Burner, Jason Linkins and Lincoln Mitchell via Huffington Post, and of course, Howard Dean.
This debate has gotten vicious and personal at times, with both sides speaking their traditional lines: the reasonable, pragmatic supporters of the bill look down their noses at the opponents and accuse them of being spoiled perfectionist brats who will never meet a piece of legislation they don’t bitch about (Jonathan Chait is among the most condescending of these people), while the idealistic, principled opponents of the bill accuse the supporters of being corporate-bought, small-minded sellouts.
A parallel debate, as Glenn Greenwald and Ed Kilgore pointed out in an excellent must-read, is between liberals who mostly want government to provide for the people directly, and those who prefer government to do so by cajoling, reforming and regulating private actors. This debate is not totally connected to the practical vs. idealistic debate – Krugman, for example, is practical about the current Senate bill while also supporting direct government programs like single payer and a WPA-style jobs program – but there’s a lot of overlap. Namely, those who like or are open to private groups performing public services are okay that this bill would make that happen for health care, whereas those who support direct government action, such as myself, are unsatisfied.
So, while I don’t claim the same kind of stature as the liberal luminaries I’ve listed above, I’m sure everyone is dying to know: where do I stand?
I will first deal with the issue of the current Senate bill, then look at other versions of health care reform and possible solutions from here on out.
Senate Health Care Bill
Normally, I associate more with the idealistic, let’s-shoot-for-the-stars crowd rather than the pragmatists who defend that which is slightly higher than crap. Likewise, I am a very vocal proponent of direct government action and resent the outsourcing of government duties to for-profit private entities. So you might think I’d be a sure bet for the idealistic, kill-the-bill crowd. But actually, for the last month (as I wrote in My Thoughts on Health Care, Part III), I’ve been undecided.
I wanted to like this bill. I understood and felt the emotional argument that screamed, “support this bill or people will die”. There were other arguments for the bill designed for liberals. If I had a dollar for every time I heard or read “don’t let the perfect be the enemy of the good!” I’d probably have enough money to pay for universal health care myself. Then there’s the “pass it now so we can fix it later”, and pointing at Social Security as an example. Of course, there’s the “if we don’t pass it now we’ll have to wait twenty years for the next chance”. But the argument was always capped off with “the status quo is so bad, if we don’t pass this crap millions of people will suffer and die”.
Well, yes, there are those appeals and they are powerful. But believe it or not, there are arguments against them too:
- Don’t let the perfect be the enemy of the good. Okay sure. But where’s the “good” here? I and many others don’t consider the Senate bill to even be good.
- Pass it now so we can fix it later. Where will the energy and pressure be to “fix” our health care system after we pass this? Our esteemed leaders in D.C. will be saying, “we dealt with health care! What more do you want?” As it is, Senators don’t want to deal with health care anymore now and we haven’t even passed the bill into law yet.
- If we don’t pass it now we’ll have to wait another 15-20 years for another chance. With health care the way it is now I think there’ll be ample pressure to keep us from having to wait another 20 years for health care reform. Not so if we pass a crap “reform” bill that masquerades as a solution.
- Pass it or else people will suffer and die. Setting aside a legitimate dispute about how much good this bill will actually do for people, are there things worse than sickness and death? Like slavery to a strengthened and mostly-unregulated corporate empire? I don’t mean to be callous here; no one can tell me that I don’t care about people suffering and dying. But cowering and paying tributary to evil corporations can’t be the answer.
Look, I know this issue is deeply personal and, for too many, deeply urgent. But this sort of legislative gun to the head, this “support it or these people will die!”, strikes me as unhelpful politicization of life and death. How is this any better than “rush to war or we’ll get nuked?” And the liberal opponents of the Senate health care bill, who have all offered solutions and alternatives (and yes, they’re politically realistic ones), are a whole different class than conservatives who want government to do nothing at all.
I’m a guy who wants our politicians to push for the best they can get rather than settle for watered-down crap to satisfy Ben Nelson and Joe Lieberman. I’m also a guy who thinks government should directly help people (e.g. Medicare for All or public option) rather than subcontracting its duties to private entities. Given that this Senate bill is both watered-down and has government handing its responsibility over to private health insurance corporations (the same ones that screw over and kill people on a daily basis, to boot!), why should I support this bill? It goes against all my political instincts and cherished principles, one of which is that I would not support any bill that had an individual mandate but no public option.
The final test on whether I should support it or not was laid out on My Thoughts on Health Care, Part III, where I compared the Senate health care bill unfavorably with the Medicare prescription drug benefit that was passed in 2003. Both are corporate-backed bills that appear to provide badly-needed benefits to people, but do so through private corporate channels and thus strengthen the same bad private actors that were the cause of the mess to begin with, as well as weaken the government that can actually provide the real solution. I opposed the Medicare drug benefit law then for this reason, and it would only be consistent for me to oppose the Senate bill for the same reason. A well-intentioned effort to convince me that they’re not the same was not persuasive.
I also find it very telling that the liberals and Democrats who are for the Senate bill now and are using the four arguments I listed above, didn’t seem to care for those arguments back in 2003, when they mostly voted against the Medicare drug benefit law, even though those four arguments were just as applicable then as they are now. In my mind, they are not being consistent. I want to emphasize this for any pro-Senate bill liberals who want to talk down to me about health care: If you were against the 2003 Medicare drug benefit law, you have NO RIGHT to lecture me on any of those four arguments listed above. Opposing the Senate bill, on the other hand, would be consistent with my most cherished principles.
So, I hereby render my final judgment on the Senate health care bill: while I would have voted to advance it forward out of the Senate, I would oppose a final, post-conference committee bill if it was like the Senate bill, in that it had an individual mandate WITHOUT a public option. By oppose I mean I would vote NO on both cloture AND passage. Yes, this means I would join a filibuster of a final bill that had no public option.
My two main deciding reasons are this:
- The Senate bill that requires everyone to have health insurance does NOT provide a public/government health insurance alternative to private insurance.
- The Senate bill is very similar to the 2003 Medicare drug benefit law, which I opposed.
I should also add a note about the proposed Medicare buy-in for 55-64 year olds: this was a very good policy addition and a real step towards Medicare for All, but as long as it was restricted for 55-64 year olds only I could not support it. It would need to be available to everyone affected under the mandate (i.e. be on the insurance exchange) for it to have my support. This is because restricting it to 55-64 year olds would leave those under 55 (such as myself) facing an individual mandate with no public alternative. However, because this Medicare buy-in could theoretically be expanded (“fixed”) in the future, I could potentially be persuaded to support it.
Where Do We Go From Here?
Earlier this month, House, Senate and White House negotiators were working out a compromise between the House and Senate legislation. This compromise would have included several positive steps, like a national insurance exchange instead of state-based ones, and modification of the excise tax on high-end insurance plans, but it apparently did NOT include a public option, since Joe Lieberman held all the power and he flatly was opposed to any bill with a public option.
If this compromise made it to the Senate and had an individual mandate but NO public option, as was likely, I would have voted NO on cloture – meaning I’d join in filibustering it – and NO on passage. (As a sidenote, I would have been the only Senator to filibuster it from the left, which would have made things very interesting and could’ve changed the entire dynamic of the public option fight.)
With Republican Scott Brown picking up Ted Kennedy’s Senate seat in Massachusetts, Democrats feel they no longer have the votes to pass any health care bill through the Senate. (Side question: How do they expect to get anything done for the rest of this year?) The new strategy being discussed is using the reconciliation process, which bypasses the filibuster and is normally used to pass unpopular deficit-reducing legislation. Reconciliation is governed by a set of rules about what kind of legislation can be passed with it, but because the public option would significantly reduce the cost of the bill, it would most likely qualify for it.
In what is popularly called “Plan B”, the House would pass the Senate bill verbatim, while the Senate passes a package of modifications demanded by the House through reconciliation (the “reconciliation sidecar”). I would support this ONLY if one of those Senate-passed modifications is a public option and if the Senate passed its sidecar first.
Another idea being floated around, especially by liberals on FireDogLake, is to disregard the original House and Senate bills altogether, and just pass something simple through reconciliation, such as an expansion of Medicare/Medicaid/SCHIP, or a government catastrophic insurance fund. I would support either of these proposals.
The last thing we should do, of course, is run and hide. Oh wait…
Here’s where I map out how I would vote/think about all the various solutions being offered for health care reform.
Remember, my first choice from the beginning is Medicare for All. If the Weiner and Sanders amendments for Medicare for All had come up for a vote, like they were supposed to but didn’t, I would have voted Yes. For the record, I’m even open to a “socialized medicine” system where the government directly employs health care providers, like it is for hospitals in the UK’s National Health Service, and in our own Veterans Health Administration. I’d have to study the issue more to be fully on board but it seems to work well in those two examples, and it’d be very much compatible with my pro-direct government ideology.
My second choice is a mandate, but with a Medicare buy-in for everyone serving as the “public option”. Note that the proposed Medicare buy-in for 55-64 year olds only does not qualify.
My third choice is a mandate with a “strong” public option that uses Medicare’s infrastructure, such as its reimbursement rates and provider networks. This was the public option that passed out of the House Ways and Means and Education and Labor Committees but failed in the Energy and Commerce Committee. I don’t know if there was a vote on it in Energy and Commerce but if there had been I would have voted Yes. I do know there was one in the Senate Finance Committee and I would have voted Yes.
My fourth choice is a mandate with a “weak” public option where the government negotiates its reimbursement rates with providers. This is as low as I’m willing to go. I would have voted Yes on this in the House Energy and Commerce Committee, the Senate HELP Committee and the Senate Finance Committee.
I will now divide my hypothetical voting record between the House and the Senate.
If I were in the House of Representatives:
· Vote on House bill: Yes, because it has a public option, albeit one that uses negotiated rates.
· Vote on post-conference final bill, as planned before Scott Brown’s win: No, despite its improvements over the Senate bill, because it would have no public option.
· Vote on Senate bill as is, in conjunction with hypothetical Senate reconciliation sidecar: No
· Vote on Senate bill as is, in conjunction with passed Senate reconciliation sidecar with NO public option: No
· Vote on Senate bill as is, in conjunction with passed Senate reconciliation sidecar WITH public option: Yes
· Vote on stand-alone bill for expansion of government health insurance and/or government catastrophic insurance: Yes
If I were in the Senate:
· Vote on Senate bill with state opt-out public option (Harry Reid’s original, post-committee merged bill): Yes, since it still has a public option. Even though that public option can be taken away on a state-by-state basis, it would be the people choosing to take it away and deny themselves the choice of government health insurance (either directly or indirectly through their elected representatives).
· Vote on Senate bill with triggered public option and Medicare buy-in for 55-64 year olds (what we had after compromise with Ben Nelson, Blanche Lincoln, Mary Landrieu, and Joe Lieberman, before Lieberman screwed it up): No, since this Medicare buy-in doesn’t cover those below 55. However, as I noted above, I could be persuaded to change my mind based on the possibility of expanding the buy-in in the near future.
· Vote on Senate bill with triggered public option and Medicare buy-in on the insurance exchange and available to uninsured of all ages: Yes
· Vote on Senate bill with just triggered public option (what we got after Lieberman screamed and got his way): Yes if my vote is necessary for cloture and passage; otherwise No on both cloture and passage
· Vote on post-conference final bill, as planned before Scott Brown’s win: No on both cloture and passage, despite its improvements over the Senate bill, because it would have no public option.
· Vote on reconciliation sidecar with NO public option: No
· Vote on reconciliation sidecar WITH public option: Yes
· Vote on stand-alone bill for expansion of government health insurance and/or government catastrophic insurance: Yes