August 31, 2009

Public Option

The discussion topic this week is healthcare reform. The poll asks whether Democratic legislators should vote against a bill that doesn't include a public options, but here in the comments let's elaborate a bit: under what circumstances should Democrats vote against reform? Under what circumstances should President Obama veto a bill?


Unknown said...

I don't think it's possible for Obama to veto a bill. If he gets nothing at all, his administration will be crippled. He has to latch onto whatever he can get and call it a win. But it's not a win. At this point, I think the best hope we have for real health care reform is to wait another fifteen years and hope that the next Democratic president has bigger balls.

MosBen said...

You think it's Obama's lack of balls that's stalled this? I can't say I'm not disappointed in how this has turned out, but he's done pretty much everything that healthcare reform supporters thought he should have based on Clinton's failures: He left the process to Congress, he got just about every stakeholder to support reform, or at least not fund anti-reform media blitzes, he's avoided using his big megaphone to get involved in the process too early which presumably would have left him with no clout left at the end of the process.

I'm increasingly convinced that the problem isn't presidential. Great presidents of the 20th century tried and failed to get major healthcare reform. Johnson went with Medicare/Medicaid because he didn't think he could get healthcare reform through Congress. The problem is that we have a system that's not conducive to passing big pieces of legislation, and it's only gotten worse in the last twenty or so years.

Until the Senate ditches the filibuster entirely, or gimps it in some way that greatly restricts its use, we'll never see major healthcare reform or cap 'n trade, or anything else sweeping. In the mean time, small reform is still good and necessary, it's just disappointing. If President Obama manages to get the insurance reforms through (no lifetime benefit limit, no pre-existing conditions), that will help millions of people. If he's able to expand eligibility of Medicaid to 300% of poverty, that will help millions of people.

Our system will still be fundamentally broken, but it will be less broken. And then in a little while we make another push and get some more things fixed.

Unknown said...

That Obama lacks balls is the best case scenario, the benefit of the doubt option. What I really believe is that he is fundamentally not on our side. It isn't about reforming healthcare, it's about securing the continued financial support of industry lobbyists to the benefit of Democrats. That's why Obama hasn't used his megaphone to target centrist Dems, but he has used it to tell Progressive Dems to STFU about the public option already. He has used it to threaten Progressive Dems that he'll sit out their re-election campaigns if they don't get in line behind the corporate giveaway he's putting together.

And the system won't be less broken. It will cover more people, and that's good as far as it goes, but it won't contain skyrocketing costs. Which means that people will continue to lose their insurance coverage at faster and faster rates as employers continue to shift premiums onto their employees, lay off more workers, or stop offering benefits altogether because they can't afford it anymore.

This whole conversation has been too much about covering the uninsured, but that's not even the real problem. That's a symptom of the problem of costs. And other than the public option, I haven't seen any proposal that has any hope of controlling costs.

Besides, when Ezra is reporting that there's a debate in the White House over whether the current plans are a) too generous, or b) way too generous, when in fact they are c) not nearly generous enough, how do you expect me to feel?

The goalposts keep moving as to the timetable. First, we were supposed to have a bill before the August recess. That didn't happen, so we were supposed to build momentum through the August recess. The reverse happened. Now, having a bill signed before the end of the year is starting to doubtful. And with ever delay in the schedule, the policies under discussion get worse and worse.

Face it, we lost. Again. With a popular president and 60% majorities in both Houses of Congress, we still lose.

MosBen said...

Well, it depends on what you call losing. If failing to pass an enormous, history-changing bill is losing, then we'll probably lose just as every attempt at large-scale health reform has lost. If that's the only way for reformers to "win", then we'll probably never win. Our system just isn't set up for moving large pieces of legislation and it's only gotten worse in the last decade or two. That being the case, the loss isn't because of Obama, it's because the system is fundamentally broken insofar as it is incapable of addressing big problems over short time lines. The best we can hope for are small to medium changes that make things better incrementally.

And you don't really address it, but many of the changes being proposed *do* make the system better. Does it fix it? No. Will solve the all of the problems in our healthcare system? No. But getting coverage to people who don't have it is good. Making sure that people with pre-existing conditions can get insurance is good. Making sure that people with catastrophic medical conditions don't get dumped because they've used up a lifetime limit is good.

And the public options that have been proposed won't solve the problem either. The House bill's public option will cover what, 10 million people or so? Look, the most sure way to solve out system's problems is single payer, but that was never on the table. And yeah, it should have been on the table, but it never would have been in the final product.

The White House has said, for months if not right from the start, that the public option is only a piece of reform, and they're right. The public option in any form that's been discussed this year, isn't a cure all for our problems. Expanding the health insurance exchanges and expanding the income maximum for Medicaid are more important for reform, but some people have decided that the public option is the only standard for success.

Would I like to see a public option? Absolutely, but I'll consider the bill a success if it passes and makes people's lives better.

Unknown said...

But you're not even talking about the real crisis, and that's my point. All of those things you mention are good, and they will improve people's lives. But they won't do anything to slow down the skyrocketing costs of healthcare. And that's losing. It means that in ten years we'll be in a worse situation than we are today, when premiums have doubled while wages have continued to stagnate.