This is not a prediction. It is only what I see as an optimistic scenario.
What’s going to happen with healthcare reform in Congress? Your guess is as good as mine. Because there is no leadership, no one knows what the outcome will be.
We do know a few things, however. Since it was given away before the issue was put on the table, there will be no single-payer system. In other words, there will be no real reform. My optimistic scenario really devolves into a hope that we get a couple of the crumbs that remain.
What remains will be an expensive mess that will further enrich the healthcare industry. Why? Because Obama learned the wrong lesson from Clinton’s failure.
Obama saw Clinton’s failure as being partly due to the opposition of PhRMA, AHIP, AMA and AHA. He decided to lure them into being allies. PhRMA agreed, if they could get his promise to accept their phantom concessions in return for increased looting of the national treasury, i.e., more subsidies and getting the government to guarantee them more customers. They got that promise.
The American Health Insurance Programs industry group is in a death match fight against reform, even though they would benefit more than anyone else from it. The AMA is fighting it but they represent only 20% of physicians. Fifty-nine percent of physicians support single-payer. Seventy-five to seventy-nine percent support the public option.
The American Hospital Association isn’t fighting quite as hard because they want to maintain communication, in the hope of getting greater subsidies. They are crying crocodile tears while still spending tons of money against reform.
The other lesson Obama thinks he learned was that the Congress didn’t go along because Clinton gave them a plan in which they had no input. That is only partially true.
What lessons should Obama have learned? There are two. One is that people respond to leadership, even when they are not in full agreement. Bush understood that. He called himself the decider and the Republicans followed. Even some Democrats fell in line. Obama started off by saying he would let Congress lead. I cannot, for the moment, think of a funnier joke. I doubt there is one.
The other lesson should have been that people are averse to complexity. A thousand-page bill offers the opposition a million points of attack. But it offers potential supporters only the opportunity to run around like a chickens with their heads cut off trying to defend against those attacks. Supporters are enervated by the effort to defend, leaving little energy or time to organize effective support. They are in a permanent defensive mode.
That could have been overcome with a simple Medicare-For-All bill of perhaps 10-15 pages. Then his primary tactic would be a constant parade of seniors extolling Medicare. A high degree of visibility for seniors would also intimidate Congress to some extent as seniors are much more likely to go to the voting booth.
Okay. Let’s get to my little scenario. There are 5 bills; 2 in the Senate and 3 in the House. Each house will combine its bills. There will be one for each. All except the Senate Finance Committee have the public option. It may end up in the Senate’s final bill. It may not. It will be in the final House bill.
Each house votes on their own bill. Then they go to the conference committee. Even if the public option is not in the Senate bill, it is likely the House will insist on it being in the compromise. The House will pass it. Obama must have something to show for his efforts. He will have to exert all of the pressure he can on Senate Democrats.
It will require going the reconciliation route if there are not 60 votes. Reconciliation allows the funding aspects to pass with only 50 Senators plus the Vice President. The other parts still would require 60 but a few Senators could vote against it on the funding part but for the other part. This would give them some political cover by saying that they voted against funding it.
It is still doable but nowhere near a certainty. Any public option that survives will be watered down. It will not be available to everyone. Various versions see it covering from 5 to 20 million of the uninsured.
Any bill will contain bans on denying people for preexisting conditions but that won’t be a problem for the insurance companies to find a way around by charging outrageous premiums or more subtle tactics.
They can avoid the ban on annual and lifetime limits by the same tactic. They don’t have to pay for people they don’t insure.
As I have contended all along, without a single-payer system, reform is little more than a catch phrase.
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As usual, another great read. I can’t speak for everyone here, but I enjoy your views on topics like these.
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