Category: Healthcare Reform
Nailed It!
Donna Dubinsky had an op ed in the Sunday Washington Post that was the most insightful analysis of the Affordable Care Act and it’s constitutionality that I’ve seen. According to legal experts who watched the oral arguments, the big question for Kennedy is what the limits are on Congress if they allow it to pass a law requiring individuals to purchase health insurance. The so-called “broccoli question,” i.e. could they require people to buy broccoli because it’s healthy and would tend to reduce costs to the system and thereby reduce insurance premiums. People I respect call this argument silly, but Ms. Dubinsky, a software entrepreneur explained why health insurance is unique better than anything I’ve read on the case.
Here’s her simple test:
There are two simple limiting conditions, both of which must be present: (1) it must be a service or product that everybody must have at some point in their lives and (2) the market for that service or product does not function, meaning that sellers turn away buyers. In other words, you need something, but you may not be able to buy it.
She then goes on to apply her test to some of the other situations raised by the conservatives to make the requirement seem unprecedented, including broccoli, health clubs and burial services, and shows how healthcare is different. She is shocked that the defenders of the law didn’t come up with this simply construct. So am I.
It was a brilliant piece and I hope Justice Kennedy reads the Sunday Post.
Gail Collins Gives Me Pause
In today’s New York Times, Gail Collins takes on the contraception issue in a very powerful way. As noted elsewhere on this blog, I have expressed sympathy with the Catholic Church. I won’t restate my case, except to say I do respect the Church’s consistency on issues of procreation. Still, I can also see the other side and wish there was some way to “split the baby,” so to speak.
Here are the two most powerful excerpts from Ms. Collins’ piece:
When I was first married, my mother-in-law sat down at her kitchen table and told me about the day she went to confession and told the priest that she and her husband were using birth control. She had several young children, times were difficult — really, she could have produced a list of reasons longer than your arm.
“You’re no better than a whore on the street,” said the priest.
That just pisses me off. And then her summation:
We are arguing about whether women who do not agree with the church position, or who are often not even Catholic, should be denied health care coverage that everyone else gets because their employer has a religious objection to it. If so, what happens if an employer belongs to a religion that forbids certain types of blood transfusions? Or disapproves of any medical intervention to interfere with the working of God on the human body?
I had been thinking about the Christian Scientist. What do they do? Can they forbid coverage of any real treatment of their employees? I am also hearing that many states require this coverage without much controversy. If the Church is already offering such coverage, then the precedent is there. What are we arguing about?
It is a tough issue and I am getting wobbly.
What Is It About Opthamologists?
I really struggle to understand how somebody who can handle the intellectual rigors of medical school can be so dumb when it comes to public policy. What’s up with that?
Economic catastrophe
Republicans have predicted economic catastrophe as a result of the passage of the the Health Reform legislation. It is reminiscent of the predictions of disaster after the Clinton budget of 1993. That budget led to the best economy in a generation and, for the first time in decades, a federal budget surplus.
Their predictive powers are apparently undiminished as the stock market cast its judgment on health reform with a triple digit rally today.
If I were a Republican today, I would feel a cold chill. Some, like David Frum, can see the future and it’s not pretty for them.
Obama is Doomed!
The press purports to explain the problems. “Why The President’s Men Stumble,” a New York Times headline promised to explain.
Another lede concluded that the president’s “once-dazzling political momentum … has stalled.”
A noted columnist captured the pack’s mood: “the Washington press corps is suddenly in hot pursuit of ‘an administration in disarray,’ which is coming apart at the seams under … a ‘detached President.’ ”
The distinguished dean of Washington columnists opined, “it is becoming increasingly clear” that the president’s marvel “was a one-year phenomenon … what has been occurring since is an accelerating retreat … a process in which he is more spectator than leader.”
These quotes are from 1982 and are about the collapsing Reagan Administration. We all know how that ended, right?
I just hope the Democrats in Congress realize that their only hope is to “PASS. THE. DAMN BILL.” with apologies to Andrew Sullivan.
Reality Check
But I don’t think anybody with half a brain (and maybe that excludes more people than it should) doesn’t realize that the Democrats problems are overwhelmingly tied to the fact that we’re in the midst of the worst recession since the end of the Second World War. Whether it’s 75% of the problem or 80% or 90% I sort of go back and forth on in my mind. But clearly this is overwhelmingly the issue.
That said, for the life of me, I can understand why they haven’t passed the Senate bill with the reconciliation fix on healthcare.
The Frying Pan or the Fire
Since the Massachusetts election debacle, we have come to an interesting place on the healthcare debate. There are two schools of thought on the situation:
1) The Democrats moved too far to the left and lost the independents. Therefore, they need to dramatically scale back their ambitions on healthcare reform. Either cave to whatever the Republicans want, or pass some modest tweaks.
2) The Democrats moved to far to the center, trying to accommodate centrists or even Republicans, constantly compromising to the point that the base of the party became disillusioned. So, the solution is for the House Democrats to suck it up, pass the Senate bill and work on tweaks through the reconciliation process that only requires 51 Senate votes in order to enact legislation.
Politically, I can’t really say which analysis is correct. Interestingly, adherents of both schools of thought claim that following the other will result in an election catastrophe in the Fall, if followed. In that respect, they both could be right. Who knows. That’s a long way off. Stuff happens. No one would have predicted Sen. Scott Brown, even as near as a month ago.
Politics notwithstanding, only option 2 will result in significant policy change. The House has already passed a healthcare reform bill, one that is even more liberal than the Senate. Republicans are going to try to hang that around Democrats’ necks no matter what happens next. There is no increased political risk to voting for final passage and, having actually accomplished something, there could be less.
They have to pass the Senate bill.
Krugman on the Team
But, best of all is this opening paragraph:
A couple of notes to address complaints about the Senate bill from the left and the center. (There’s no use addressing complaints from the right; in general, the safest thing when dealing with crazy people is to avoid eye contact.) Emphasis added.
Celebrating Healthcare Reform
Today, he comes out in strong support of the Senate healthcare reform bill. Yes, it is a compromise, but a compromise that represents and massive change in direction in American politics. Of course, he does take a gentle shot at Obama by pointing out that the bill is closer to Hillary Clinton campaign proposal than to Obama’s. But his conclusion is strong:
And for all its flaws and limitations, it’s a great achievement. It will provide real, concrete help to tens of millions of Americans and greater security to everyone. And it establishes the principle — even if it falls somewhat short in practice — that all Americans are entitled to essential health care.
While I am pretty far to the Left ideologically, I am also a pragmatist when it comes to policymaking. As I’ve noted in a previous post, the bill will be seen as one of the great legislative achievements of the past fifty years. I’m glad Krugman agrees with me.
Perspective
