Posted by: Jeff | November 2, 2009

Momentum for Health Care Reform

Speaker of the House Nancy Pelosi is sending the health care reform bill to the floor of the House of Representatives today, meaning that both the Senate and the House have active versions of the bill on the floor.  We’re pushing much closer to vote on passage in both chambers, a step that could come within the next week or so.

The debate on health care has simmered a bit despite the progress made toward passage in the past few weeks.  As I see it, I think there are two reasons why reasonable discourse has prevailed.  First, the vociferous criticism of reform has been based largely on broad ideological generalizations and not on details included in proposed legislation.  And second, reform is turning out to be a lot cheaper than most people thought.

Health Care Support By Demographic and State (Columbia University)

The debate over reform has been cast in a number of lights, many of them not helpful in illuminating the particular reform being considered.  To those on the Left, reform is about universal health care access as a right.  To those on the Right, reform is about a government takeover of the private sector.  The actual bills being reported to the floor are not accurately depicted by either side, and yet these are the predominant discourses exchanged on the subject.

Both bills do expand coverage, but do not do so in a universal way.  According to the LA Times, over 17 million Americans would still be without coverage under the Senate plan on the floor.  Though this is a significant improvement in access for the additional 20 million that would be covered by reform, it is not in any way universal.  Senate Democrats claim this is an effort to cut costs in the face of widespread resistance to a strong public option.  The House version does include a public option that would expand coverage slightly, giving 36 million Americans the option to “opt in” to public coverage.  The most vehement conservative resistance to passage is naturally in the House.

Now that actual bills have been reported to the floor, mischaracterizations are harder to make.  Sarah Palin made headlines this summer in reference to alleged “death panels” embedded in the government that would effectively decide who has access to health care and who does not.  This has been thoroughly debunked.  Other critics claim that the government is trying to replace the market.  Well, this has been debunked as well: even the House version, which includes a public option and a government-regulated exchange for private coverage comparison, does not in any way mount a challenge to private insurance plans.  According to “Under the House bill, people who want to buy new individual, nongroup coverage will have to purchase it through a new health insurance exchange. They can still buy private insurance – the exchange, in fact, would offer a range of private plans, in addition to a new federal health insurance option.” It is also worth mentioning that the Congressional Budget Office projects that only 6 million Americans will opt in to the public option – a figure considerably less than those newly insured that will be purchasing private plans.  If anything, private insurance companies will see an increase in the number of buyers purchasing new plans.

The CBO has released a report that analyzes costs over the next ten years and reveals that reform will actually save the government money.  A key criticism levied at the notion of reform has been escalating public costs that would necessitate rising taxes.  However, according to the CBO: “enacting H.R. 3962 would result in a net reduction in federal budget deficits of $104 billion over the 2010–2019 period.” Furthermore, the language currently on the floor of the Senate also represents a reduction in cost to the tune of about $81 billion in deficit reductions over the next ten years.  In other words, reform is actually cheaper than doing nothing.  Suddenly this doesn’t feel like socialism.

I think as the American public (and punditry) have more time to immerse in the details, support for reform will start to rise.  The first sign is a tempering of the opposition to reform.  Soon independents may start to shift over.  President Obama may also be moving back toward inclusion of a viable public option as a baseline.  In the words of Paul Krugman, the CBO reports are illuminating that reform is moving in a progressive direction.


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