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Book of Matthew: Examining the House health care bill

Published: November 13, 2009
Section: Opinions


Give a hand to the House of Representatives.

By a vote of 220-215, the House boldly went where no Congress has gone before on Saturday, approving the greatest overhaul of the health care system since the inception of Medicare over four decades ago.

Democrats who supported the measure hailed the Affordable Health Care for America Act of 2009 as “historic,” pointing out that in the long history of American health care, we have never been this close to a system that actually works for everybody.

No kidding. As far as real reform is concerned, members of the House could have passed a bill written in wingdings and still have surpassed the work of many of their predecessors. So perhaps calling the thing “historic” is a bit of a given. My question is: Are the specific provisions in the bill the kind of rules that we need to govern health care?

My answer? Yes and no.

First, let’s take a look at some of the bill’s brighter spots:

It contains a public option. Yes, you read that right. Despite the claims of countless Republicans that the public option was “dead” and unworthy of further consideration, (and despite a collective “Woe is me!” from panicked, ready-to-cave Democrats) the bill calls for the creation of a government-run insurance plan to compete with existing private plans. With this in place, millions of Americans who previously could not afford or could not qualify for health insurance will now be able to get coverage.

The bill also calls for the creation of the health insurance exchange that was so frequently touted by President Obama and other Democrats during the campaign season. The idea is to create a pool of insurance-seeking customers for insurance companies to compete over, thereby forcing the companies to lower costs and improve services. It operates under the same principle that large businesses use to get deals on bulk health insurance for their employees, and it should, in theory, reduce costs for everyday Americans as well.

The bill even addresses the problem of private health insurance companies treating their customers poorly. It prohibits insurers from charging a patient different rates or even denying coverage altogether simply because of that patient’s “pre-existing conditions.” This is a particularly welcome change, considering that in the insurance world, the term “pre-existing condition” covers just about everything a person could ever imagine going medically wrong.

Finally, the bill has received a favorable rating from the Congressional Budget Office (CBO), or at least as favorable a rating as an officially non-partisan federal agency can offer. The CBO found that over a period of ten years (2010-2019), the House bill, if enacted into law, would actually reduce the government’s yearly budget deficit by about $109 billion.

So far, so good. But like any piece of legislation, especially one this enormous (1990 pages), the bill is far from perfect.

The first problem is that all public options are not created equal. While many progressive Democrats would have preferred to include a “robust” public option—that is, a public plan that pays for care at Medicare rates plus five percent—conservative “Blue Dog” Democrats pushed for a watered-down version that will instead negotiate payment rates with doctors and hospitals. This version, which was adopted into the final bill, will likely offer rates that are more closely tied to those of private insurance companies, thereby hindering its ability to compete with the industry.

Ironically, our friends at the CBO found that the watered-down public option will actually save the government less money than the “robust” version. And yet, the Blue Dogs championed the diluted plan as part of their effort to cut the final bill’s costs and make it more “bipartisan.”

(I never quite got the logic behind this move. Perhaps the Blue Dogs figured that if they weakened their plan so that it merely looked like it involved less government spending, they would make the bill more inviting to the government health care skeptics out there. Or perhaps, being more pro-business than the average Democrat, they liked the idea of giving the private industry more of an edge. Or perhaps they’re just stupid.)

But possibly the most ridiculous aspect of the bill came in the form of an amendment put forward by Representative Bart Stupak (D-MI). The Stupak Amendment prevents government money—either in the form of public option payments or subsidies for private insurance coverage—from being used to pay for abortions. This was put forward as a way to pick up a few more votes in favor of the bill, by calming the hearts and minds of Congressmen who claimed to be “morally opposed” to taxpayer money going toward the funding of abortions.

(With that in mind, I’ve got a few quick questions: What if anti-war legislators were to band together and prevent government money from being spent on the military? What if states ended the use of the death penalty en masse? What if Representative Pete Stark (D-CA), Congress’ only openly atheist member, introduced legislation ending the tax-exempt status of religious organizations? Would any of that count as “moral opposition?”)

Anyway, I’m beginning to digress. The point is, although this is certainly not the worst bill that could have been passed, it’s not the best either. Regardless of what conservatives say about this bill satisfying top-secret liberal goals (of killing freedom, if you must know), we’re actually dealing with something that is pretty moderate overall. Most of the bill’s provisions are compromises that were worked out after weeks, if not months, of deliberation. Of all the ways to reform health care, this should have been one of the least controversial.

And yet, take a look at the vote count. On the left, 219 Democrats supported the measure, while 39 voted against it (presumably Blue Dogs who were allowed to vote freely by Speaker Pelosi once it was certain that the bill would pass). On the right, 176 Republicans voted no, leaving only Representative Joseph Cao (R-LA) to brave the inevitable storm of right-wing public opinion and vote yes. With these numbers, you would think that they were actually voting on whether to rename the country the United Socialist States of America. (Actually, I think Glenn Beck mentioned something like that…)

If it was that difficult to pass a bill like this in the House, I can only imagine what will happen when the Senate gets its 200 hands on it. Senator Lindsay Graham (R-SC) keeps telling the press that it will be “dead on arrival.” Senator Joe Lieberman (I-CT) is threatening to filibuster. Countless other Democrats, yes, Democrats, are calling for the removal of the public option and the insertion of even more anti-consumer, pro-health industry provisions.

Sounds like fun.

Time for some heavy paraphrasing of Robert Burns: The best-laid health care plans of Congressional men are often cast astray.