Saturday, December 19, 2009

Healthcare Reaches Take It Or L:eave It Stage

I have never claimed to be the brightest light in the room, which makes me wonder why the major newspaper websites are claiming victory for a healthcare reform bill cobbled together by Senate Democrats. With Sen. Ben Nelson finally aboard, all that does is snuff a Republican filibuster. The floor vote is scheduled Christmas Eve.

A lot can happen between now and Thursday evening. That's plenty of time for Connecticut Independent yo yo Joe Lieberman to change his mind 144 times which is about every hour on the hour.

To win their support, Majority Leader Harry Reid has promised several hundred millions of dollars to Mary Landrieu for Louisiana and anti-abortion and other special waivers to Nebraska for Nelson..What he give to Lieberman? A CEO job at Aetna? Or any other recalcitrant senator playing King For The Day?

Okay, I get it. If cloture is cut off, the bill will need only 51 votes in the senate to pass on Christmas Eve. That leaves a margin of nine Democratic senators to vote against it. It will provide cover for Democratic moderates that include the likes of Jim Webb of Virginia, Ben Cardin of Maryland, Lincoln and McCaskill of Arkansas, Landrieu, Nelson and ... Oops. It's getting close. What if liberals such as Bernie Sanders of Vermont and Ron Wyden of Oregon join the pack in protest?

Some may call it the art of compromise. I call it prostitution under the guise of principle. While on the subject, the people who the healthcare plan was to help got partially screwed. I say partially because there appears to be some inherent good coming out of this legislation. Stack it up to doing nothing and it looks even better.

The healrthcare plan would increase insurance coverage for 31 million more Americans. The Washington Post summarizes the highlights:

Instead of a public option, the final product would allow private firms for the first time to offer national insurance policies to all Americans, outside the jurisdiction of state regulations. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress. 

Starting immediately, insurers would be prohibited from denying children coverage for pre-existing conditions. A complete ban on the practice would take effect in 2014, when the legislation seeks to create a network of state-based insurance exchanges, or marketplaces, where people who lack access to affordable coverage through an insurer can purchase policies. 

Insurers competing in the exchanges would be required to justify rate increases, and those who jacked up prices unduly could be barred from the exchange. Reid's package also would give patients the right to appeal to an independent board if an insurer denies a medical claim. And all insurance companies would be required to spend at least 80 cents of every dollary they collect in premiums on delivering care to their customers. 

Every American would be required to obtain coverage under the proposal, and employers would be required to pay a fine if they failed to offer affordable coverage and their workers sought federal subsidies to purchase insurance in the exchanges. Reid's package would offer additional assistance to the smallest businesses, however, increasing tax credits to purchase coverage by $12 billion over previous versions. 

The overall cost of the package was not immediately available, but aides said it would be more than covered by cutting future Medicare spending and raising taxes in the health sector, including a 40 percent excise on the most expensive insurance policies. The package would reduce budget deficits by $130 billion by 2019, aides said, and by as much as $650 billion in the decade thereafter.(These projections appear to concur with those compiled by the Congressional Budget Office.)

And, what did Nelson get for playing hardball?

Under the new abortion provisions, states can opt out of allowing plans to cover abortion in insurance exchanges the bill would set up to serve individuals who don't have employer coverage. Plus, enrollees in plans that do cover abortion procedures would pay for the coverage with separate checks - one for abortion, one for rest of health-care services. 

Nelson secured full federal funding for his state to expand Medicaid coverage to all individuals below 133 percent of the federal poverty level. Other states must pay a small portion of the additional cost. He won concessions for qualifying nonprofit insurers and for Medigap providers from a new insurance tax. He also was able to roll back cuts to health savings accounts.

During a news conference this morning, Nelson said: “Change is never easy, but change is what’s necessary in America, and that’s why I intend to vote for health care reform.” He also vowed to vote against the expected conference reconciliation bill if "anything" in it fails to meet his approval.

Although I would prefer a single payer plan by extending Medicare to all or even by lowering its age limit to 55 or even a robust public option, the Senate bill as I understand it is good enough for starters just like any foreplay.

I do not subscribe to the doomsday vision that the bill should be defeated as championed by Howard Dean and It's gone too far and torn the country apart simply through the debate process. What glitches crop up can be fixed or killed by future congresses.

I expect hundreds of tiny details to expose themselves as time goes by and the bill is honestly vetted. One horror story repeated on MSNBC is that some insurers will comply by offering coverage to patients with pre-existing conditions but at premiums up to five times higher than those without.

One thing we can all agree upon. The healthcare and insurance reform bill was the focus of a national debate. That's a far cry from the Bush administration which said "trust me" as it bullied us into the invasion of Iraq.

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