Healthcare passed... healthcare killed?

Dan Froomkin reports that state budget cuts and caps on benefits are already undermining the health insurance reform package:

Sunday's House vote means there's a new era dawning for health insurance in this country -- but not for tens of thousands of poor children about to lose their coverage, or the hundreds of thousands of poor families about to suffer the brunt of significant Medicaid spending cuts.

That's because while the health care debate has been raging in Washington, the recession continues to rage everywhere else. And state governments across the country are dealing with massive budget shortfalls by reducing spending on the people who need it most, with health costs a chief target.

. . .

The Republican governor and state legislature of Arizona last week made national news when they eliminated the state's Children's Health Insurance Program (CHIP), eliminating coverage for nearly 47,000 low-income children.

. . .

And yet despite that, states are slashing Medicaid spending where they can -- by reducing reimbursement rates to providers and cutting or capping various benefits.

"They're not actually cutting people off but, in some cases, what they're doing is paying providers less, so it's harder for people to get the services that they need," Guyer said.

For instance, in Tennessee, Gov. Phil Bredesen is capping inpatient hospital services for most Medicaid recipients at $10,000. In Nevada, the legislature has put in place new limits on the number of diapers and bed pads available to incontinent Medicaid patients.

Yeah- the Medicaid system, intended to protect the poorest among us, will only pay $10,000 for a hospital stay in Tennessee. That can be the cost for one day in a hospital- or even for one TEST in a hospital, depending.

And with Republicans promising to use every tactic to repeal or undermine the health insurance reform bill, you can bet that more Medicaid and SCHIP cuts- or outright abolitions- are in the queue. That's why this bill is so horrible- it leaves virtually everything up to the states, the majority of which are still run by Republicans dedicated to rallying their base by seeking to destroy the safety net the Democrats are weaving with all the dexterity of knitters wearing oven mitts.

But are the supporters of the plan worried by the fact that everything they've promised relies on the good will of their sworn enemies to happen? Noooooo. In fact, they're making lists of all the stuff they say will happen immediately... which, ironically, helps reveal what WON'T happen immediately, or maybe ever.

Let's start at the top: #1: No pre-existing condition ban. For children. The overall ban on denying coverage for everyone with a pre-existing condition doesn't kick in until 2014- long after the next presidential election.

#3: Seniors will see the Medicare Part D "donut hole" closed by 50%... but not because coverage is going to be expanded. No, instead there will be tax rebates- long after the money was spent, IF the senior has it.

#5: Lifetime health insurance benefit caps are history, as of now. Annual benefit caps, though, continue until 2014.

#6: Remember #1? Well, there's a temporary high-risk government pool for pre-existing condition people... until 2014, when they'll have to rely on the state-run insurance exchanges. I'm not confident...

#7: If you get a brand-new health insurance plan now, it has to cover checkups and other preventative care. Your existing plan, however, if you have one, isn't obliged to do so until 2018- after Obama's out of office even if he wins in 2012.

#15: Fast food places have to put nutrition info and calorie count on all their menus. Including their DRIVE-THROUGH menus. Um... those things are hard enough to find stuff on ALREADY...

So... a lot of the stuff you thought you'd get now isn't coming for several years... and, even if the bill isn't repealed or overturned by the majority-conservative Supreme Court, a lot of the stuff might not come to pass AT ALL.

That's what comes of "bipartisan compromise."

Aftermath: What Have We Learned from Health Care Reform?

Begin with this article by Tom Schaller at FiveThirtyEight.com.

Tom's bullet points:

1. Non-incremental policy change is never easy.

2. The presidential pulpit doesn't bully by itself.

3. Misinformation is more easily disseminated than debunked.

4. Have an Administration bill.

5. Proxying process for policy works.

6. It pays to hold out.

7. Bipartisanship is a waste of time—except as a tactical feint.

All of which are true, but they dance around the core points a bit. Here's my version.

1. Fighting requires leadership. Nobody ever said something as initially ambitious as health care reform would be easy. Even with Democratic supermajorities, it was known by everyone (except Barack Obama and Max Baucus) that the Republicans would do everything in their power to sabotage their efforts. This was going to be an uphill struggle from the start... and the man who was elected, in no small part, to see it happen began by telling Congress, "Do something!" and then sitting silent in the White House for seven months. Such leadership as there was until last month came not from our president, but from two deeply unpopular and divisive figures, Nancy Pelosi and Harry Reid- which allowed the Republicans to turn the American people strongly against the whole process.

2. Leadership requires having specific, clearly defined goals, and a plan to achieve them, beforehand. Obama deliberately did not have this- taking the wrong lesson from Hilarycare. Hilary Clinton's 1993 effort failed because she shut out everyone else from the decision-making process, presenting her plan as a take-it-or-leave-it package. Obama responded not by sitting down with his party's Congressional leadership and thrashing out a plan, but by having no plan whatever- leaving it to Congress to make something up that he'd claim as his own after the fact. This left him- and the entire Democratic Party- impotent to defend a plan that didn't even exist from the attacks of Republicans and their media spokespersons.

3. Leadership requires expressing, repeating, and defending that plan. Obama, having no specific plan to defend, spent months generally silent, saying only that "we have to have health care reform" with no solid definition of what shape it would take. This allowed Republicans to lie broadly and shamelessly about the plan, defining it before the Democrats could. In popular opinion, the Democrats have yet to recover from this total strategic failure- and barring a tremendous rally by Obama this fall or the disintegration of the Republican machine, they will pay for it in the election to come.

4. The modern political process doesn't give a rat's ass about the truth- only about what sounds best. Beginning with Sarah Palin's "death panels" lie, the television media- and, indeed, most of the print media as well- have entirely failed to call out Republican talking points on their innacuracy or outright deception. This is fair enough, though, since the media has also failed to call out the Democrats- once they finally got something to bring to the people- on the empty nature of their own claims in support of the bill. About the best that can be said on the Democratic side is that they didn't lie so much as present the perfect best-case scenario for how their overly compromised plan would work. Net result: support and opposition for the bill had nothing to do with any actual, truthful facts, and everything to do with fear, anger, and partisan loyalties.

5. The Democrats, contrary to what Republicans claim, do not have any unifying ideology except greed for power. The only way the Democrats got the bill through the House was to guarantee that health insurance coverage for abortions would be henceforth illegal. One out of eight Democrats still voted against the bill- mostly because it was too strong rather than not strong enough. In the Senate, Max Baucus, Ben Nelson, Blanche Lincoln and Joe Lieberman each extorted concessions that weakened the final plan to the point of impotence while, in the process, destroying the public opinion of the bill through such things as the "Cornhusker Kickback." By contrast, the Republicans- who have been fighting to purify their ranks- stood from beginning to end united as a solid wall against the whole process, even working to deliberately undermine and delay it. The Democrats could not hold together when it counted.

And, last but most of all:

6. What is done in Washington is done for absolutely no other reason than political tactics. Despite the rhetoric, virtually nobody in this whole process on either side stood on principle or voted according to the good of the nation. The final passage of the Senate bill last night in the House came about not because of Democratic unity on the bill, but because of Democratic fear of the consequences should they spend so much time on the effort to come up with nothing. Republicans, on the other side, scarcely even pretended to cooperate with Democrats to find a compromise- despite the pre-compromises initiated by Barack Obama. They knew, from the start, that they would gain absolutely nothing by cooperation, but by determined opposition they could rally their base and take advantage of Democratic divisions. In the end, Republicans opposed what is essentially Massachusetts' Romney-care on the national level not because of the merits but because Democrats proposed it. Likewise, Democrats voted for the final bill not because of the merits, but because they would suffer at the polls if they failed to pass anything- no matter how horrible what they passed was.

We desperately, DESPERATELY need something else in our politics.

Was I wrong? I dunno...

Yesterday I said that Republicans didn't dare call out the racists in the Tea Party, because without the racists they lose.

Well, it turns out that the Republican leadership was denouncing those racists after all... or were they?

House Minority Leader John Boehner, R-Ohio, called the incidents "reprehensible" but said on NBC's Meet the Press "let's not let a few isolated incidents get in the way of the fact that millions of Americans are scared to
death, and millions of Americans want no part of this growing size of government."

. . .

"Nobody condones that at all," said House Minority Whip Eric Cantor, R- Virginia. on ABC's "This Week." "There were 30,000 people here in Washington yesterday. And, yes, there were some very awful things said."

. . .

On CNN's "State of the Union," Rep. Mike Pence, R-Indiana, called the slurs "contemptible," saying, "I denounce it in the strongest terms."

. . .

As demonstrators gathered outside the Capitol Sunday to rally against the bill, one held a sign saying, "All tea partiers: If you hear a racial slur, step away, point, boo and take a picture of the rat bastard."

This is nice of CNN to report, but look at what I've bolded above. The leadership did not go in front of the tea partiers and denounce racism. They went on television news programs- none of which the teabaggers watch or trust, since the only news source they believe is Fox News.

And the only direct rejection of racism addressed to teabaggers was by... a sole, anonymous teabagger.

This is standard Republican tactics: say one thing in front of the loyal, another in front of the media, and ignore those who point out that the two contradict one another.

If someone knows of an elected Republican calling out racists in the teabagger protests on Fox News, or denouncing it at an actual teabagger rally, please let me know. Until then, I decline to retract my position: Republicans are too dependent upon racists and bigots within their party and within the teabagger movement to denounce them to their faces.

EDIT: A political cartoonist who was on the ground Saturday reports that the incidents were not as "isolated" as Boehner would have us believe...

... and a blogger, without attribution or details, reports a Republican congresswoman from Missouri as encouraging Tea Party racism. Don't know about this one, but maybe more will come out.

President Nancy Pelosi

According to the New York Times and Politico, Barack Obama was not the one who circled the Democratic wagons and revived health insurance reform to the point that today's vote could happen.

It was Nancy Pelosi, the stories claim, who stood up to both Barack Obama and his chief of staff Rahm Emanuel, who wanted to settle for minor changes to health care after the election of Republican Scott Brown to Ted Kennedy's former Senate seat.

During a mid-February conference call with top House Democrats, Pelosi made it clear she would accept nothing short of a big-bang health care push – dismissing the White House chief of staff as an “incrementalist.”

. . .

The groundwork for Sunday’s vote was laid out during a three-day marathon White House negotiating session, which took place in the week before the Massachusetts special election Jan. 19. ... there was a stark reminder during those three days of the differing styles of the House and the Senate, and how that divide would define the next two months.

On the second day, Obama asked the House and Senate leaders to return after dinner with $70 billion in suggested cuts from the bill. The senators hunkered down in Sen. Max Baucus’s office, ordered pizzas and drew up a list of trims. Each senator gave up something, aides said.

Later that night, back at the White House, the House presented its approach: They would cut nothing. Obama, not persuaded, sent them to different rooms, and told them to keep working at it.

Eventually, they whittled the gap down to $20 billion, and Obama made his own suggestions.

Henry Waxman, chairman of the House Energy and Commerce Committee, seemed pleased. “I don’t speak for the House, but you have put forward a serious set of numbers,” he said to Obama, according to a person present.

Pelosi was not so impressed. “Mr. President, I agree with Henry on two points,” she said before turning to Waxman. “The president put out a set of numbers, and you don’t speak for the House of Representatives.”

Obama was done. He left the room in frustration, telling his aides to deal with it.

. . .

Around the time of Brown’s victory, Pelosi and her staff became alarmed by reports, in the New York Times and elsewhere, that consensus was growing for the House passing the Senate bill as-is – with no reconciliation.

Pelosi, according to several associates, went through the roof, telling Obama and Emanuel that there was no chance her members would pass the Senate bill with its excise tax and sweetheart deals.

It was Nancy Pelosi, not Barack Obama, who provided the leadership required to get the Democrats back on track for their major legislative agenda item of the Congressional term. Obama, rather than leading, followed her lead- almost completely unable to get her to bend or even give on anything.

This story reinforces what has become more and more apparent as time goes on: Barack Obama is a legislator, not a leader. He can campaign well and give good speeches at rallies, but aside from this he has shown absolutely no leadership qualities at all. The closest he has come to doing so is through his continued efforts to ensure that the crimes of the Bush Administration go forever unanswered for...

... which, considering Nancy Pelosi's past history on the subject, might also be a case of Pelosi's leadership rather than Obama's own.

And, to be honest, Nancy Pelosi is not a President I would ever, ever have voted for. In addition to being completely opposed to holding war criminals accountable (possibly because she herself is complicit in at least some of those crimes), she has a record of putting her own and her party's electoral prospects ahead of the good of the country- and even ahead of the things her party supposedly stands for, as I believe the current health insurance reform bill is a prime example.

But we've seen it since the stimulus package debate last year, when Nancy Pelosi took Obama's proposals and basically said, "Who runs Bartertown?" You can't even really say that Barack Obama has ever backed down from Nancy Pelosi... because, for the most part, he's never STOOD UP to Nancy Pelosi.

Or, for that matter, to pretty much anyone.

Well, the odds are very good that next year Pelosi will merely be Minority Leader- if that- and Obama will face instead Speaker John Boehner and a Republican majority. Maybe then we'll see some leadership out of him- although I severely doubt it.

In the meantime, Nancy Pelosi is effectively President, at least on all domestic affairs... and 1600 Pennsylvania Avenue is just a house.

Dancing With Them What Brung Ya

The teabaggers are getting more vile- and more violent.

Threats of death to Barack Obama, threats of armed revolt against the federal government- these are nothing new. But a few days ago a Virginia tea party protester said that if health care reform passed, there would be "a new civil war." A brick was thrown through the office window of a Democratic representative from New York.

And then, just yesterday, teabaggers crowded several Democratic representatives, including openly gay Barney Frank and civil rights movement veterans Jim Clyburn and John Lewis.

A staffer for Rep. James Clyburn (D-S.C.) told reporters that Rep. Emanuel Cleaver (D-Mo.) had been spat on by a protestor. Rep. John Lewis (D-Ga.), a hero of the civil rights movement, was called a 'ni--er.' And Rep. Barney Frank (D-Mass.) was called a "faggot," as protestors shouted at him with deliberately lisp-y screams.

The above linked article, when I read it, also came with a photo gallery of protest signs. Most of them were vile, but the worst was placed first: "If Brown Can't Stop It, a Browning Can." If you're not looking at the picture, Brown refers to Senator Scott Brown (Republican-MA); Browning is a make of firearm.

And this violence didn't stop with the signs, according to Talking Points Memo:

Standing next to Lewis, emerging from a Democratic caucus meeting with President Obama, (Representative Andre) Carson (D-IN) said people in the crowd yelled, "kill the bill and then the N-word" several times, while he and Lewis were exiting the Cannon House office building.

Death threats based on race: that's where the teabagger movement is now.

The reaction of the left to all of this was immediate and firm: such behavior is completely unacceptable. A Democratic member of Congress took the floor last night to confront Republican members on their support for the tea party movement, demanding that they stand up in public and denounce the racist and violent behavior of the teabaggers.

Dennis Palumbo of The Huffington Post sums it up pretty well:

...it's no longer just the health care bill ---it's about the Republicans' shameful silence in the face of escalating hatred and divisiveness on the part of Tea Party members. Where is the GOP leadership on this issue? Why aren't prominent Republicans on CNN and Fox News and CNBC decrying these racist and defamatory remarks?

What else does their silence indicate but agreement? Or at least a willingness to ride this growing tide of racist hatred to further their own political gain, in the upcoming mid-term elections and beyond. The health care debate has been debased into an excuse to roil frustrated Americans into an ugly, divisive frenzy, with the tacit support of the so-called mainstream GOP.

. . .

To the GOP leadership: regardless of the seats you hope to get in November in the mid-terms, you're only showing that, once again, political gain trumps the national interest.

So either speak up now, denouncing the haters, or accept that most reasonable people assume you agree with them.

At least one Republican was not at all slow in his response: specifically, to blame the Democrats for the racism.

Rep. Devin Nunes (R-Calif.) came to the defense of the racists and bigots who shouted slurs at members of Congress Saturday. The Tea Party protesters shouted the ‘n’ word at African American members of Congress the ‘f’ word at an openly gay member.

. . .

“When you use a totalitarian tactics, people, you know, begin to act crazy,” Nunes told C-SPAN’s Steve Scully Sunday morning when asked about the slurs. “I think that people have every right to say what they want. If they want to smear someone they can do it. It’s not appropriate--I think I would stop short of characterizing the 20,000 people protesting, that all of them were doing that.”

And when he says, "It's not appropriate," what he means is, "It's not appropriate to claim that all of the teabaggers were shouting, 'kill the bill and then the n----r.'"

He- and his fellow Republicans- are not even willing to say that it's wrong for anybody, ever, to call someone else "nigger." (Which it is. I spell out the word here only because I'm sick and tired of hiding from a word, no matter how evil the word is.)

Republicans are not even willing to say that it's wrong to call for the violent overthrow of the government.

Of course, the reason why this is is obvious. Even if you're willing to believe that most Republicans are not themselves racist (such as Paul Broun (R-GA), who equated health reform's passage to "the Yankee War of Aggression" on the House floor) or in support of the violent overthrow of the federal government (Michele Bachmann)... the party's elected officials are now utterly dependent upon the votes of those people who ARE racists, who ARE bigots, and who DO want the federal government destroyed unless they're the ones running it.

Without such voters, South Carolina and Alabama- to name but two- would be solid blue states.

And, of course, since this constituency has become the indispensable base of the Republican Party, more and more often they are electing their own to Congress- as witness Bachmann again, or Broun, or Nunes, or Jim DeMint, or any number of others. Which means that the longer the Republicans are completely dependent upon these voters for their continued survival, the more the Republican Party as a whole will resemble them.

But no elected Republican (except perhaps for Scott Brown or Olympia Snowe) dares stand up to these people and say, "You are wrong. What you say- what you advocate- is vile. I cannot and will not support or endorse these things, and I will not associate myself with people who do."

They can't do it... because these people are who got them elected in the first place.

And thus the Republican Party slips a little deeper into its identity as the Party of Evil.

EDIT: Nunes has been joined by the perennial wingnut loudmouth, Steve King (R-Iowa):

Rep. Steve King (R-Iowa), a leading voice in the tea party movement, said Sunday that protesters’ recent use of racial and homophobic slurs toward Members of Congress was no big deal.

“I just don’t think it’s anything,” King said, emphasizing that the incidents were isolated. “There are a lot of places in this country that I couldn’t walk through. I wouldn’t live to get to the other end of it.”

Yeeeeah. "There are a lot of places in this country that...I wouldn't live to get to the other end..." Nooooothing racist in that, I don't think.

But, since there are obviously people somewhere who would kill a white man on sight, just for being white, that makes threatening black Congressmen- or even the President- hunky-dory.

My friends, I give you the Republican Party- and brother, you can HAVE it.

Scared Shitless of a Mouth

The other day Eric Holder was confronted by Republicans who want to prevent any nasty icky Muslim terrorists from ever being tried like the criminals they are.

Eric Holder, like his boss Barack Obama, caved in to them:

Mr Holder's response dodges the question a bit, but it also seems to suggest he doesn't like the idea, and thinks it's a Republican attempt to portray his administration as soft on terrorism.

Osama bin Laden "will never appear in an American courtroom," Attorney General Eric H. Holder Jr. told House members at a hearing Tuesday.

"Let's deal with the reality here," Holder said in response to questions from Rep. John Culberson (R-Tex.). "The reality is, we will be reading Miranda rights to a corpse."

The blogger who quotes the above says that trying Obama would be a good idea. I agree. I MORE than agree.

There must be some part of my brain that's still frozen in September 10th 2001 mode, because I just can't remember the chapter in American history where we apparently decided that criminal trials are some kind of favour we do for terrorists that proves we're postmodern multicultural cowards who lack confidence in our own civilisation, or whatever. Seems to me that if a trial was good enough for Adolf Eichmann and Saddam Hussein, it's good enough for Osama Bin Laden.

Exactly.

Let's look at the Constitutional protections for justice:

The privilege of the Writ of Habeas Corpus shall not be suspended, unless when in Cases of Rebellion or Invasion the public Safety may require it. - Article I, Section 9, Paragraph 2

The Trial of all Crimes, except in Cases of Impeachment, shall be by Jury; and such Trial shall be held in the State where the said Crimes shall have been committed; but when not committed within any State, the Trial shall be at such Place or Places as the Congress may by Law have directed. - Article III, Section 2, Paragraph 3.

No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a Grand Jury, except in cases arising in the land or naval forces, or in the Militia, when in actual service in time of War or public danger; nor shall any person be subject for the same offense to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law... - Amendment V.

In all criminal prosecutions, the accused shall enjoy the right to a speedy and public trial, by an impartial jury of the State and district wherein the crime shall have been committed, which district shall have been previously ascertained by law, and to be informed of the nature and cause of the accusation; to be confronted with the witnesses against him; to have compulsory process for obtaining witnesses in his favor, and to have the Assistance of Counsel for his defence. - Amendment VI.

Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted. - Amendment VIII.

...nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws. - Amendment XIV, Section 1.

You will notice that, in every single quote here, there is no mention whatever of citizenship. The Republicans claim that all of the above protections only apply to American citizens... yet this is utter bullshit. These are not privileges granted only to citizens, to be ignored when dealing with foreigners; these are restrictions on the federal government. These are either things the federal government MUST do, or CANNOT do, when dealing with criminals.

It is unconstitutional to revoke the writ of habeas corpus except in case of domestic rebellion or armed invasion by a foreign power- PERIOD.

The Constitution demands a speedy public trial by jury for those accused of crimes.

The Constitution (Antonin Scalia's beliefs notwithstanding) prohibit cruel and unusual punishments- and also prohibit self-incrimination. That means, twice over, NO TORTURE.

And finally, after the Civil War, the Fourteenth Amendment passed all of these protections down, imposing them on the states- and, again, making the most basic ones available not solely to American citizens, but to any person whatever held within the jurisdiction of the United States, by any level of government.

And yet the Republicans claim that we need to overturn all of this, and hold people accused of terrorism- not convicted, merely accused by a single person- in prison indefinitely without trial or even legal counsel. Why?

Because of what these people might say at their trial.

PLEASE.

We tried Hermann Goering in an international court. We gave him full legal representation. We let him testify. We let him talk as much as he wanted- and oh, boy, did he talk. And then we proved, beyond all doubt, that he was an integral part of the Nazi war machine that killed millions of soldiers and tens of millions of civilians- including millions of German citizens.

And along with Goering we tried von Doenitz, Albert Speer, and dozens upon dozens of other Nazi leaders and commanders and officials, giving them all the opportunity to speak. This had some unusual results- Speer, for example, effectively pled guilty and gave testimony to both the evil of the Third Reich and the intense charisma that Hitler used to gain and hold power. In a few cases- Hjalmar Schacht, for example- were even found innocent of Nazi Germany's crimes against humanity.

And that's not all. We also tried Japanese war criminals- over five THOUSAND of them.

But, you say, these were not terrorists? We also tried the perpetrators and mastermind of the first World Trade Center bombing. We tried Terry Nichols and Timothy McVeigh for the Oklahoma City bombing. We tried Richard Reid, the "shoe bomber."

And why did we give all of these people, who in most cases richly deserved what was coming to them if not more, a trial?

Because that is what we Americans call JUSTICE.

Because we, as a nation, are BETTER than these people who commit murder on a mass-production scale. Because our forefathers, having firsthand experience of a government which denied jury trials and which occasionally imprisoned people with no legal recourse whatever, wrote it down, and then reinforced it, that these things would NOT BE PERMITTED in their new country thenceforth.

And yet the Republicans are scared shitless that, because the accused has the right to testify in his or her own defense, that these terrorists would open their mouths in court and thereby, just possibly, persuade people to join their cause. For this threat- the threat that a man, in shackles and an orange jumpsuit, who may or may not even speak English, could undermine our country with words alone- the Republican Party, as a whole and virtually without exception, is willing to throw out our entire system of justice.

COWARDS.

Pathetic, bullying cowards, so convinced of the fragility and weakness of the republic they claim to hold dearer than all other things that they will throw out everything that makes the republic worth having in order to defend it.

COWARDS!

And yet... they are not the biggest cowards.

The biggest cowards are the people who keep caving in to Republican bullying- who support indefinite imprisonment of Guantanamo prisoners, military trials or no trials at all for many of them, and who are willing to abandon their attempt to try even one of these men for his crimes- and to even ridicule the idea of trying anyone in the future.

Cowards like Eric Holder, and Barack Obama.

Democrats, Republicans... cowards, all.

We need something else.

My Final Decision: I'm Against the Reform Bill

As the title says: I'm against what's likely to be passed in the next week or so. Oh, I grant you it'll be disastrous for the Democrats if it fails, and their only hope of avoiding a Republican takeover of at least the House if not the Senate as well. On that ground- and on that ground ALONE- I hope it passes.

But, in and of itself, not as a political move but as a simple law, it's a bad idea. It won't work. And here's why.

Today somewhere or other I found a link to this extremely simplified explanation of what the health insurance reform plan does. It's a good summary. Let's start with this:

If you already have coverage through your employer... you keep it. And the government would offer small business incentives to provide coverage to their workers.

This insurance is strengthened by:

• Banning exclusions for pre-existing conditions
  
• Banning lifetime and annual caps on how much insurers will pay out for care
  
• Capping consumers' annual out-of-pocket expenses
  
• Requiring full coverage for preventive care
  
• Allowing young adults to stay on the family's plan until they turn 26 years old

All well and good... but there's something utterly vital missing there.

There is absolutely no provision to cap how high insurance premiums can go, or how much they can be raised each year or due to changes in medical condition.

Insurance corporations can go to the limit- and well beyond.

Moving on:

Medicaid will be expanded to cover an additional 16 million Americans.

Which would be all well and good, if Medicaid were solely a federal program. It's not. The bulk of funding for Medicaid comes from the states, nearly half of which have governments whose governors or attorney generals have pledge to sue to have this bill declared unconstitutional. Even now these states want Medicaid killed; my state, Texas, has driven up the requirements to qualify for Medicaid to such an extreme, and driven so many off its rolls, that they no longer meet the minimum qualifications to receive ANY federal matching funds for Medicaid at all. In short: what this bill promises on Medicaid, the federal government is powerless to deliver.

Onward again:

State-based health insurance exchanges will enable these individuals, families, and small businesses to join together in larger risk pools to purchase private health insurance coverage at affordable prices.

Except the bill only empowers states to create these exchanges- it doesn't force them to. Again, nearly half the states want this bill struck down; they certainly will NOT cooperate with it in any way.

The new system will cost about $100 billion each year. Much of these new funds will be used to provide tax credits to offset costs for those individuals, families, and small businesses that still cannot afford to buy insurance and other improvements to the health care system.

Except, well, this cost estimate, and the ability of the federal government to provide these subsidies (which don't kick in for five years at least), rely on the overall cost of health insurance either remaining stable or coming down. As I mentioned above, there is absolutely no guarantee of this whatever. Indeed, in half the country the insurance exchanges which are supposed to provide competition among corporate insurance plans won't even happen because of Republican opposition to any sort of aid to the poor whatever.

And the subsidies come in the form of tax credits- which means you have to have the money for the insurance plans up front for a year before you can hope to get any money back at all.

And there is absolutely no guarantee that these tax credits will be anything like enough to offset the uncontrolled rise of health insurance costs. The only help here is that the penalty we would pay for not having health insurance would be waived if- in the opinion of the IRS- the minimum health policy available to you would cost more than 15% of your gross (not net) annual income.

Onward:

We will save money by:

• Eliminating waste, fraud, and abuse, as well as subsidies for health insurance and pharmaceutical companies
  
• Better coordinating care to eliminate unnecessary hospitalizations and duplicate tests
  
• Better utilizing electronic medical records
  
• Paying for quality and not just quantity

Obama already introduced subsidies for electronic record-keeping systems. In fact, some doctors' offices have tried implementing such systems, at their own expense. The results: HIGHER expenses and SLOWER performance, because current laws- which this bill does not, to my knowledge, address- PROHIBIT the sharing of medical information without the patient's express permission, and thus the systems aren't talking to each other... and it's faster to write things on paper than to enter them into a computer.

The other items, to be blunt, are empty Washington talking points, with no substance.

And finally, let's look at what this plan doesn't even address:

• It does absolutely NOTHING to stop health provider corporations, such as hospitals and chain/franchise clinics, from raising their charges astronomically to take advantage of the requirement that insurance companies cover services- which has happened in Massachusetts where a virtually identical program has been in force for years;
  
• It does absolutely NOTHING to address the sky-high price of prescription drugs and the non-competitive market practices pharmaceutical companies engage in;
  
• It only offers "support to state governments to find solutions" to frivolous malpractice lawsuits, tort reforms, and malpractice insurance premiums; and
  
• It does nothing to address the practice, common at all levels of health care, of padding bills with unnecessary tests, outrageously marked-up supplies and over-the-counter medicines, and other additional charges and services included not to avoid lawsuit but simply to maximize profit.

So, in summary: this bill provides no, absolutely no guarantee that we will be able to afford health insurance, or that health care costs will go down or even level off... but it requires everyone in America but the truly indigent to buy it, at full cost, cash up front, in the hopes that whatever tax credits they get the following year will make them whole. It addresses absolutely none of the basic problems which have caused health care to become so expensive in the first place. The one good thing it does is that it requires health insurance corporations to take all comers and provide the coverage they promise... provided you, the customer, have infinitely deep pockets. (And if you do, what do you need with insurance anyway?)

This bill is a disaster waiting to happen. The only argument in its favor, from where I sit, is that if the Democrats spend all this time and effort and fail to pass it, the Republicans will regain power- and they are currently ruled by the most nakedly racist, bigoted, intolerant, evil and corrupt politicians to be found in our country.

But once this bill takes effect, and health insurance costs skyrocket, and other health care costs continue to rise without any foreseeable end in sight... won't the Republicans get back in power anyway?

The Democrats did this to themselves- pushing forward a program without first, in advance, making sure that their own party was united on what to do. By compromising, and compromising, and compromising just to keep their own party together- plus Obama's idiotic pre-compromises in an obviously futile effort at "bipartisanship"- they've destroyed everything good that might have been in this bill... and gained, in its place, a dog of a bill that they either kill (in which case it will be said Democrats are incapable of running the government) or pass (in which case I expect the results to be so horrible as to give Republicans another decade or more of absolute power).

We're damned if they do, and damned if they don't.

Damn them.