"If Health Care Reform Dies . . ."
"'Health Care Reform' has only suffered a flesh wound." - Village Bloggers (h/t KD commenter.)
As part of the Village Bloggers' attack on Howard Dean, I enjoyed our friend Kevin Drum's turn of phrase:
If healthcare reform dies this year, it dies for a good long time.
If? Oh. I see. The Senate bill is "health care reform" for Kevin. Let's count the reasons why:
* Insurers have to take all comers. They can't turn you down for a preexisting condition or cut you off after you get sick. [How much can they charge you for that?]
* Community rating. Within a few broad classes, everyone gets charged the same amount for insurance.[A few broad classes? Hmmm. Define "a few broad."]
* Individual mandate. I know a lot of liberals hate this, but how is it different from a tax? And its purpose is sound: it keeps the insurance pool broad and insurance rates down. [It is like a tax where the purpose is to bribe the insurance companies to accept health care reform. How precisely it keeps insurance rates down is not apparent to me. I understand that broadening the risk pool is supposed to keep down rates but that is in a world of effective competition. Where's the reform on COMPETITION in this bill?]
* A significant expansion of Medicaid. [Let's wait to see what Nelson does to the bill first.]
* Subsidies for low and middle income workers that keeps premium costs under 10% of income. [See above. Let's wait for Nelson.]
* Limits on ER charges to low-income uninsured emergency patients. [Change you can believe in.]
* Caps on out-of-pocket expenses. [Not really. Kevin needs to read the fine print there.]
* A broad range of cost-containment measures. [HAHAHAHAHAH!]
* A dedicated revenue stream to support all this. [Which revenue stream is that? Oh, he means the excise tax. Um, I am pretty sure that one is regressive. Bad point Kevin.]
Look. I can see supporting this bill IF the Medicaid expansion stays in at current levels with the House financing mechanisms. the mandate is a high price to pay and unless it is sunsetted, kills any chance for real health care reofrm.
But the argument that Kevin forwards - that this bill is good health care reform is absurd. At this point, I do not agree with Howard Dean, but I see his argument - this bill DOES kill health care reform for a generation. By pretending to be reform. By giving up the mandate for so little.
At the heart of this is the Village Wonk belief that the Exchange will be the competition mechanism that can be expanded to be meaningful. howard Dean does not believe this. He believes that absent a public insurance component, there will be no meaningful competition and thus no meaningful reform.
This has been at the heart of this disagreement the whole time -- the Village bloggers' disdain for the public insurance programs as "reform" and "cost containment." Taken at face value, their view of health care reform is pretty much Joe Lieberman's (and that is perhaps why they launch vicious attacks on Lieberman - so this fact is not quite so apparent.)
It is an honest disagreement. It would be nice if the Village bloggers could be honest enough to acknowledge what the disagreement is.
Speaking for me only
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