Saturday, October 31, 2009

Heading Not To Confrontation

Conservatives, rest assured. Health insurance companies, break out the champagne. The Congressional Budget Office has “scored” the bill unveiled by House Speaker Nancy Pelosi and The Hill offers these highlights:

- The bill would reduce the ranks of the uninsured non-elderly by 36 million, "leaving about 18 million non-elderly residents uninsured (about one-third of whom would be unauthorized immigrants).
- Roughly 21 million would purchase insurance on their own through insurance exchanges.
- Total enrollment in the public plan would be about 6 million, or one-fifth of the total consumers shopping in the insurance exchange.
- State spending on Medicaid would increase on net by about $34 billion between 2010 and 2019.

The CBO concluded the bill, if enacted, would not explode the budget, but instead be deficit-neutral. Illegal immigrants would not be insured. A mere 20% of the 30 million Americans (a mere 10% of the population) eligible for the public plan would take it. And still, approximately 12 million non-elderly legal residents would remain uninsured.

This House bill, bolder than that endorsed by Senate Majority Leader Reid and whatever would eventually be enacted, should have brought comfort to the right and discomfort to the left.

Evidently, it has not. On Thursday, the House Tri-Caucus (Congressional Black Caucus, Congressional Hispanic Caucus, Asian Pacific American Caucus) and the Congressional Progressive Caucus all met with President Obama. (No word on any scheduled meeting with the Congressional non-Hispanic white caucus.) Raul Grijalva (D.- Arizona), head of the House Progressive Caucus, stated on Democracy Now! that the group was concerned there are no “cost controls on the private insurance companies, especially with negotiated rates, because they get to set the rates and we have to chase those rates with taxpayers' dollar; and no triggers and no opt-outs, that we feel those are detrimental to the public interest and certainly to constituencies that have lacked the ability to access healthcare in this country for so many years.”

Then, apparently, they stamped their feet, got red in the face, and threatened to be really, really, unhappy when they vote for whatever bill is finally brought up for a vote.

While the progressive caucuses that met with the president are concerned, justifiably, by lack of cost controls and the possiblility of a trigger, an opt-out or opt-in, they ought to be worried, as the CBO explained

That estimate of enrollment reflects CBO’s assessment that a public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges. The rates the public plan pays to providers would, on average, probably be comparable to the rates paid by private insurers participating in the exchanges. The public plan would have lower administrative costs than those private plans but would probably engage in less management of utilization by its enrollees andattract a less healthy pool of enrollees.

That would be, in the words (video below) of Oregon Senator Ron Wyden, akin to a “health care ghetto,” which would seriously harm any public option that is enacted under the terms currently proposed.

The right (or at least a portion thereof), however, is going to demand its interests be met. Think Progress reports that Representative Bart Stupak (D.- MI) is threatening to block reform over the belief that the proposed bill(s) would permit subsidization of abortion, even though any subsidy would be indirect, and is arguably not a subsidy. It is a very small (though apparently to them, not trivial) aspect of health reform. And a group of Representatives may be willing to perpetuate continuation of the deeply flawed American system of health care over it.

It's their right to stake a claim on any one principle they hold dear. Progressives, however, appear at present to have little stomach to hold out for what they themselves believe in. The reasons may be complicated, and doubtless vary from member to member, but one explanation was suggested by Rep. Grijalva in the interview with Democracy Now:

We're facing the most historic vote that any of us are going to take in our careers. And for procedural reasons or for other reasons, to threaten to filibuster, to threaten to scuttle, whether it is Senator Bayh, Senator Snowe, Senator Lieberman, I think they're missing their opportunity with history, and I think the White House and leadership shouldn't allow them to be absent in this fight.

It could have been: “this is the best we can get;” or “the public option may be weak but we can strengthen it in a later congressional session.” But instead it was: It’s Historic! It’s An Opportunity With History!

This sounds suspiciously like the reason many people- liberals, conservatives, centrists- in the mainstream media (traditionally John McCain’s “base”) were giddy over the presidential candidacy of Senator Barack Obama. It gave them an opportunity to “make history.”

There was little discussion, uncomfortable as it would be, as to what “history” was being “made.” And now it seems the same concept is affecting Democrats in Congress. Health care may little improve, costs may skyrocket with the addition of roughly 36 million consumers, but at least “history” will be “made.” The alternative would be a better bill, but at the expense of confrontation few are willing to have with this this president.

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