Will The Health Bills Really Be "The Most Important Thing They Will Ever Do?"

By Big Tent Democrat, Section Other Politics
Posted on Tue Mar 16, 2010 at 08:35:00 AM EST
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Matt Yglesias reports on Speaker Pelosi's conference with some Village bloggers:

[T]he most interesting part of the discussion was when Pelosi waxed a bit expansively about the historic nature of the achievement if reform passes. She observed that with the exception of John Dingell who was around for the Civil Rights Act and Medic[a]re, nobody else serving in the House has been part of anything this important. For most of us, she said, “this is the most important thing we will ever do.”

For the life of me, I do not see it. This bill is thin gruel. Of course it has its points that are applause worthy - the expansion of Medicaid being the clear winner - but there is nothing in the reform part of the bill that I see as particularly important. And in the end, I think evaluations of the health bills really rest on whether you believe the regulatory, state exchanges model adopted by the Obama Administration will lead to meaningful health care reform. Is it a camel's nose under the tent for real health care reform? In my opinion, it isn't. YMMV. Pass it? Sure. But argue it as important, substantively and/or politically? Don't see it.

Speaking for me only

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Will The Health Bills Really Be "The Most Important Thing They Will Ever Do?" | 58 comments (58 topical)

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For the congresscritters who will lose their jobs (5.00 / 3) (#8)
by ruffian on Tue Mar 16, 2010 at 09:16:15 AM EST

over it, yes, I'd say it is a life-changing experience. For the others, not so much.

: yeah (5.00 / 1) (#19)
by Capt Howdy on Tue Mar 16, 2010 at 09:57:47 AM EST

I was going to say that
as a matter of fact I do agree that it is possible it will be the most important thing most of them will ever do.
what the hell else have they done lately.

I know it will come as no surprise to you (5.00 / 5) (#16)
by Anne on Tue Mar 16, 2010 at 09:42:14 AM EST

that I think the House/Senate bills have a long, long way to go before they could be considered "historic," lately, that term has been applied with as much frequency as the doctor labeled things "breathtaking" on "The Hamptons" episode of Seinfeld.

Is it historic in terms of its potential to change people's lives for the better? Well, it's going to take some time to have a definitive answer to that question, but given the weak and rather pedestrian nature of the so-called reforms in the legislation, I think that's going to be a huge stretch. There are reforms that are supposed to be implemented immediately, but there is still that pesky language about them applying to "new plans" that has yet to be explained; the language suggests that insurance companies will not have to extend reform to existing policies, so it will be interesting to see whether people will be required to replace old policies with new ones, and how that process will translate in terms of cost.

Will it be historic in terms of saving the government money? Not according to the projections I've seen, and not according to the estimates of actual savings that could be achieved with a single-payer system. Will it be historic in terms of cost savings to individuals? Again, not according to what I'm seeing. More of the costs appear to be shifted to the individual, making it more likely that people will still find it difficult to obtain affordable care.

Who will benefit in historic proportions? Gee, I wonder. If there is anyone who doesn't think we will be seeing headlines about the historic profits of health insurance companies, I'd like to meet them. Headlines I don't expect to see? "Improvement in outcomes soaring as Americans are healthier than they have ever been!" "Health care more affordable than any time in the last 50 years!" "Quality of employer-provided health plans top rate!"

In general, I don't think history is going to be kind to this entire endeavor, or to those who have been selling the bejesus out of it in the interest of winning one for the Gipper, I mean, Obama.

: It might be life changing for seniors (5.00 / 1) (#54)
by BrassTacks on Wed Mar 17, 2010 at 02:55:47 AM EST

and some doctors. The bill calls for a half a billion cut in medicare. No matter what Obama says, that will hurt services to seniors. It has to. Along with that some of those doctors will leave their profession when their pay is cut again. Finding docs to treat people on medicare and medicaid will become very difficult because of the cuts.

The Most Important Thing We Will Ever Do? (5.00 / 4) (#20)
by kidneystones on Tue Mar 16, 2010 at 09:59:29 AM EST

Jeebuz. I'd slit my wrists if I thought shoveling this pile of manure over the finish line was the most important thing I'd ever do, this week.

Realclearpolitics isn't clapping. TPM has resorted to directly handing out WH talking points. I get the sense that voters are going to run wild if Dems don't stop dithering and start getting serious about J-O-B-S.

If democrats pass this mess, (none / 0) (#55)
by BrassTacks on Wed Mar 17, 2010 at 02:57:55 AM EST

They will lose their jobs. Republicans are gleeful about their prospects in November if the bill is passed. They are high fiving themselves all over. It's all so discouraging. Why? Why? Why? are they doing this for Obama?


: Au contraire, I'm jubilant. (none / 0) (#59)
by kidneystones on Wed Mar 17, 2010 at 09:13:11 AM EST

The bill sucks and should not be passed. I find it unbelievable that anyone believes those with pre-existing conditions are going to be offered anything but scraps at high-prices.
Dems with wit and a strong sense of survival will plant a heel in that smirking mug and pivot.
Because if anyone believes that Obama is in this for anyone but himself need look no further than Wright and the Church that gave Obama his political career.
Every Dem up for re-election needs to look away from Washington for salvation.

When your optic is (5.00 / 1) (#21)
by BTAL on Tue Mar 16, 2010 at 10:16:21 AM EST

a mirror and on one shoulder you see the reflection of your "legacy" and on the other you see "your self-imposed position in life", of course it is: "The Most Important Thing They Will Ever Do".

I think (5.00 / 2) (#22)
by NYShooter on Tue Mar 16, 2010 at 10:17:57 AM EST

you all misunderstood Nancy's meaning in her statement. She meant it in a "political" sense, insofar as: enjoying a super majority in the Senate, a massive majority in the House, a Democratic President, and a blank check mandate from the voters, these Democrats actually passed something. (assuming they do)

Having watched them fumble & stumble this past year I would agree that passing something....anything for these Democrats would be historic.

: We need new words to replace "historic" (5.00 / 3) (#38)
by lambert on Tue Mar 16, 2010 at 03:08:11 PM EST

Like "Missed-toric" or "Phhst-toric!"
I mean, imagine! In the face of overwhelming opposition, the Dems managed to bail out the insurance companies! Hold me back! Hold me back!

: I think (none / 0) (#23)
by Capt Howdy on Tue Mar 16, 2010 at 10:23:57 AM EST

you have a point

: All in the perspective (none / 0) (#26)
by ruffian on Tue Mar 16, 2010 at 11:05:54 AM EST

If they had come out fast and modestly with this result last spring, and not made a big deal out of trying to do a "historic" reform, ie. not spent a year getting modest results, it would indeed look like an achievement, and a step in the right direction.
The best they can hope now is that the memory of the sausage factory fades by November.
Oh, and that more people end up helped by the changes than end up hurt. I think there is no way to predict that right now.

Not in the way Medicare/Medicaid was historic (5.00 / 1) (#30)
by Socraticsilence on Tue Mar 16, 2010 at 02:07:01 PM EST

Possibly in the way the Social Security was- a highly limited start that had to discriminate in order to garner the support necessary to pass (abortion restrictions here, the racism of social security).

Thanks Socraticsilence (5.00 / 1) (#34)
by christinep on Tue Mar 16, 2010 at 02:13:22 PM EST

for the perspective and reminder that very significant programs--in our history--may well begin with a few small steps toward a principled goal.


: A mindless analogy (none / 0) (#42)
by lambert on Tue Mar 16, 2010 at 03:27:04 PM EST

Since there was no equivalent of Social Security when Roosevelt introduced it.
To match the present case, there would have been a privatized pension system that profited when people died before payout, and FDR would then have reinforced their position in the system by forcing everyone to either buy their (defective) product, or go into a welfare system that demanded you sell all your assets as a condition of entry. Of course, FDR didn't do either of those things, which is why people love it and it still exists today.
Underlying the incremental improvement idea seems to be the (non)-thinking that the Dems in general, and Obama in particular, can't possibly make things worse. They can and have, in the case of FISA, by granting the telcos retroactive immunity for felonies; in the case of torture, by normalizing it; in the case of financial reform, by enabling the larger banks to become even larger.
The best thing to do with this bill would be to pass ONLY the parts that benefit people immediately, and forget about all the Rube Goldberg stuff like the exchanges, and so forth.

: A mindless analogy (none / 0) (#43)
by lambert on Tue Mar 16, 2010 at 03:27:04 PM EST

Since there was no equivalent of Social Security when Roosevelt introduced it.
To match the present case, there would have been a privatized pension system that profited when people died before payout, and FDR would then have reinforced their position in the system by forcing everyone to either buy their (defective) product, or go into a welfare system that demanded you sell all your assets as a condition of entry. Of course, FDR didn't do either of those things, which is why people love it and it still exists today.
Underlying the incremental improvement idea seems to be the (non)-thinking that the Dems in general, and Obama in particular, can't possibly make things worse. They can and have, in the case of FISA, by granting the telcos retroactive immunity for felonies; in the case of torture, by normalizing it; in the case of financial reform, by enabling the larger banks to become even larger.
The best thing to do with this bill would be to pass ONLY the parts that benefit people immediately, and forget about all the Rube Goldberg stuff like the exchanges, and so forth.

IIRC, (5.00 / 1) (#44)
by mentaldebris on Tue Mar 16, 2010 at 03:31:41 PM EST

the passage of NAFTA and the repeal of Glass-Steagall were also touted as "historic". There's nothing historic about selling out the public to the corporations and moneyed interests -- it's a daily ritual in DC.

In this hyperbolic chamber aka as the USA, I put words like "historic" in the same category as the words HuffPo and many bloggers use in headlines to describe just about any televised criticism of a political foe (rips apart, skewers, slams, annihilates, massacres, destroys, obliterates, crushes, demolishes). The words often have little to do with reality. I believe Jon Stewart effectively covered this hyperbolic tendency.

"Historic" (none / 0) (#45)
by jbindc on Tue Mar 16, 2010 at 03:40:09 PM EST

Has become one of those words that is completely overused and has lost its meaning when touted by people who work at either end of Pennsylvania Avenue.


: "Historic" should be reserved for (5.00 / 1) (#48)
by observed on Tue Mar 16, 2010 at 04:54:22 PM EST

describing the SEC football game of the week.

3-fer: Historic win, historic opportunity missed, (5.00 / 1) (#47)
by RonK Seattle on Tue Mar 16, 2010 at 04:28:24 PM EST

... and historic greasing of the skids for future P.O. and S.P. increments (converting many current situational opponents into natural allies).

I don't see it very difficult to argue (5.00 / 0) (#50)
by pluege on Tue Mar 16, 2010 at 06:01:13 PM EST

that passing legislation for the illegal, unnecessary, intentional destruction of a sovereign nation that had done nothing to the US is the most important thing those still in Congress that were there in 2002 ever do.

And for pelosi personally, protecting war criminals and a POTUS that unambiguously undertook - with pride and bravado the very reason that impeachment was written into the Constitution is likely the defining moment of her life.

: Ha, good point. If Pelosi et. al. (none / 0) (#53)
by observed on Tue Mar 16, 2010 at 06:40:09 PM EST

were headed to the gallows for war crimes, they might get your point.

I will say this for them (none / 0) (#1)
by andgarden on Tue Mar 16, 2010 at 08:42:29 AM EST

If it's true that they managed to gut the excise tax and keep closer to the House funding levels will still telling Stupak to pound sand, I will be pretty impressed. I still don't think this will work so well, but it should be a net benefit.

I don't know why they couldn't find the votes to expand Medicare, though. (Or maybe that's their "one more thing").

I agree (5.00 / 1) (#4)
by Capt Howdy on Tue Mar 16, 2010 at 09:00:44 AM EST

it is a first step. I expect there will be others. but this one was the hardest and I think I am surprised they made it this far.


The hardest? I'm not so sure (5.00 / 3) (#5)
by andgarden on Tue Mar 16, 2010 at 09:03:20 AM EST

Their inability to build on Medicare makes me think that this really is all there is.


Um Medicare (none / 0) (#32)
by Socraticsilence on Tue Mar 16, 2010 at 02:08:58 PM EST

and Medicaid for that matter have expanded pretty substantially since their initial inception.


: Medicare has? (none / 0) (#35)
by lilburro on Tue Mar 16, 2010 at 02:19:44 PM EST

It has been extended to people with disabilities, but how has it changed otherwise?

: Yes, Medicaid is substantially privatized (none / 0) (#39)
by lambert on Tue Mar 16, 2010 at 03:10:38 PM EST

(64% in 2007). I'm guessing that's why the Dems went for that solution, and not Medicare expansion -- their constituents (the insurance companies) win either way.

BTW, does a reconciliation package (none / 0) (#3)
by andgarden on Tue Mar 16, 2010 at 08:51:36 AM EST

get a motion to recommit? If so, the Republicans are obviously going to put Stupak up for a vote.


How can it possibly repeal the Constitution, ... (none / 0) (#52)
by RonK Seattle on Tue Mar 16, 2010 at 06:15:29 PM EST

... install Socialism, destroy 1/6 of the economy, and still be considered anything less than a landmark in History?

Maybe I'm reading the wrong blogs or something.


Maybe yes maybe no (none / 0) (#2)
by Saul on Tue Mar 16, 2010 at 08:46:54 AM EST

First of course IMO if it does not pass then that is the end of Obama on this and anything else he wants to push. That is of major political importance.

Of course the bill is not a public option which IMO would be more meaningful and is not in the same category of Johnson's passage of his major bills but its a start. Maybe Obama's thinking now is that this diluted bill is a starting point to build on later so it will be more meaningful down the road He knows he should of define the bill from the get go now but that is water under the bridge.

Maybe passage of this bill will give him and the democrats a momentum of power to push the other major bills he wants. Power and political capital he should of used and used from the very beginning. I feel he wasted much of his political capital. So passage of this bill is of major political importance for his future and the democrats.

: Which "public option"? (none / 0) (#40)
by lambert on Tue Mar 16, 2010 at 03:12:28 PM EST

The bait, or the switch?

So well put... (none / 0) (#6)
by masslib on Tue Mar 16, 2010 at 09:10:18 AM EST

Frankly, I would have liked to see Obama's alternative, the Medicaid expansion plus children 26 and under on parents insurance, pass, which would have covered half of the people of this current proposal at a quarter the price. But when Pelosi tries to call this the most important thing the current crop of Dem's will do in their lifetimes, I must say it's not something I would brag about.

I think this whole health care plan if ever implemented will be replaced in history by whomever and whatever group of Democrats implement at least access to Medicare to all Americans, and the regulatory approach will be lost.

The "on until 26" provision (none / 0) (#7)
by andgarden on Tue Mar 16, 2010 at 09:15:17 AM EST

is in this package. That's surely a big deal for a lot of people. I know that it will keep me off of the individual market for at least a year, for example.


Yes, there has been a movement toward that (none / 0) (#9)
by masslib on Tue Mar 16, 2010 at 09:17:05 AM EST

for a long time. Some states already have the law in place.


Well, nationalizing it is a good thing (5.00 / 1) (#10)
by andgarden on Tue Mar 16, 2010 at 09:19:07 AM EST

Some states say 21, 23, 24, 25, or nothing at all.


Well, clearly I agree... (none / 0) (#11)
by masslib on Tue Mar 16, 2010 at 09:22:52 AM EST

As I said, I would have liked to see the Obama alternative pass which covers half those covered under this leg at a quarter the price.


I think most of the cost (none / 0) (#13)
by andgarden on Tue Mar 16, 2010 at 09:29:34 AM EST

comes from subsidies and Medicaid expansion. I understand objecting to that on the basis that it's bad to pump more money into private insurers (I agree), but I think it's less bad than allowing lots of people to go without any insurance at all.

The test will be whether the insurance that people buy will be so worthwhile. I expect that it will have some real benefits, but I don't see the new regulatory structure curbing the worst abuses in any meaningful way.


Thats the point, andgarden (5.00 / 1) (#31)
by christinep on Tue Mar 16, 2010 at 02:08:49 PM EST

It socks one in the gut to see first the amount of new customers & $$ the insurance companies will realize. But, then take it to the next step--as you have now suggested--that focuses on the gains to the currently uninsured as well as those being pushed out of the market by "pre-existing conditions" or by (heaven forbid) really getting sick more than once or twice. In other posts, I've alluded to my own background as a primary negotiator in civil federal (environmental usually) settlements. A personal lesson for me from my career has been: Focus first on what you want, and don't allow yourself to get too thrown by what the other guy gets--OR accept that for most settlements, both sides get something (that is why its a settlement, say what?.) Put still another way, I've seen lots of arguments get out of control--in personal and business contexts--because of the "cut off one's nose to spite one's face" syndrome (aka trying to prevent the adversary/opponent from realizing gain as well.) I think that Sen. Bernie Sanders stated it well last night by keeping his progressive eyes on the goal and counting the gains as a first step, while reminding all that there will be more in the inevitable next phase. At least, that is where I am.


will people be able to afford the (none / 0) (#14)
by observed on Tue Mar 16, 2010 at 09:37:30 AM EST

mandated insurance? "What if you made 40,000$?"


If they can't, then their taxes go up a bit (none / 0) (#15)
by andgarden on Tue Mar 16, 2010 at 09:40:13 AM EST

(i.e., the penalty). That will be a failure of the scheme.


I take it as a given that insurance (none / 0) (#17)
by observed on Tue Mar 16, 2010 at 09:47:45 AM EST

companies will charge the absolulte allowable maximum. Is that still 8% for someone making 40,000?
I'm sure being penalized AND not being able to afford insurance will really get people voting (D)!


: the rest of us make up the difference? (none / 0) (#56)
by BrassTacks on Wed Mar 17, 2010 at 03:27:53 AM EST

We will pay our own insurance, which will increase in price since they can't exclude anyone, and we will have to pay for those who don't make enough to pay and don't want to pay?

Most of the costs is in the subsidies, expanding (none / 0) (#18)
by masslib on Tue Mar 16, 2010 at 09:48:12 AM EST

existing federal programs costs less.
This is why I think the alternative was the better proposal. 30% of the uninsured roughly are 18-24, which is why that family provision has such bang for the buck, 40% of those uninsured exceed the income requirement of Medicaid and SCHIP, while 66% of the uninsured make 200% above poverty or less. Basically, the coverage crisis can be solved efficiently by that one family provision and expanding Medicaid to incomes 200% above poverty. It can be whittled down greatly by the family provision and a more modest Medicaid expansion. Yes, I understand the arguments for the bill. I guess I prefer not to throw money at the insurers for what the government can do better and cheaper, but I don't run the show.


I mean, it covers so many in part because (none / 0) (#12)
by masslib on Tue Mar 16, 2010 at 09:24:51 AM EST

it includes that sensible provision.


You're a 2L, right? (none / 0) (#28)
by dk on Tue Mar 16, 2010 at 11:29:47 AM EST

Do you already know that you're not going to have a job when you graduate?


Are you asking (none / 0) (#29)
by BackFromOhio on Tue Mar 16, 2010 at 01:47:38 PM EST

Andgarden? If so, my guess, based on knowledge & ability demonstrated here, he's in the top of his class and will land on his feet. Law firm hiring is way down, but not non-existent for new grads.


: That would be my guess too. (none / 0) (#36)
by dk on Tue Mar 16, 2010 at 02:21:39 PM EST

In which case, I don't get why he would need healthcare through his parents' plan.

In that perspective (none / 0) (#33)
by Socraticsilence on Tue Mar 16, 2010 at 02:11:01 PM EST

depressing as it is passage would almost undeniably be the biggest progressive win since Johnson- I mean we've basically been treading water with some exansions and some rollbacks since then.


If you want Obama's alternative ... (none / 0) (#46)
by RonK Seattle on Tue Mar 16, 2010 at 04:19:02 PM EST

... please be advised that's what they're fixin' to vote into law this week and next.

BTW, dependent coverage thru 26 and Medicaid expansion were included in the House bill, the Senate bill, and the current Obama reconciliation draft.


Are you daft? (none / 0) (#49)
by masslib on Tue Mar 16, 2010 at 04:56:00 PM EST

Alternative as in NOT the current legislation, but an ALTERNATIVE proposal Obama's admin had on the back burner. It's NOT what the House plans to pass through their reconciliation bill, which IS basically the current legislation, it is an ALTERNATIVE. It is ONLY the MEDICAID/SCHIP expansion, plus the provision for 18-26 year olds. THAT is IT. Duh, those provisions were included in the House bill, the Senate bill and the Senate-plus bill, but in the ALTERNATIVE they drop the bulk of the plan, which is the individual mandate and subsidies for private insurance companies. I should rephrase, I would support the ALTERNATIVE as a sensible plan to cover more people since clearly there is no leadership for simply expanding Medicare.


: Oh, that ... 'Fallback', a.k.a. 'Plan B', etc (none / 0) (#51)
by RonK Seattle on Tue Mar 16, 2010 at 06:03:51 PM EST

Long time since that had any buzz (and that mostly in rightwing circles).
Please excuse my misunderstanding.

I know it makes them feel (none / 0) (#24)
by lilburro on Tue Mar 16, 2010 at 10:27:13 AM EST

all luverly inside, but if they intend to make changes to the framework they might want to bill it as a framework, rather than a historic achievement. Because for the life of me all I can see is that it is a framework and will require improvement.

I think it should be passed. But can we call it what it is?

No, you can't call it what it is... (5.00 / 1) (#41)
by lambert on Tue Mar 16, 2010 at 03:14:27 PM EST

... because then nobody would be able to vote for it.


for ex. (none / 0) (#25)
by lilburro on Tue Mar 16, 2010 at 10:35:50 AM EST

Obama is referring to part of the bill as a "Patient's Bill of Rights on Steroids." That seems accurate (he did a whole weekly address on this). On top of that are subsidies and a Medicaid expansion.

In terms of actual reform, the mandates seem most important. But of course they are less popular so they're hardly talked about any more (which is a remarkable achievement indeed).

The bill just isn't being sold as what it is. Which I accept from politicians but less so from bloggers.


: I thought he was against steroids? (none / 0) (#27)
by ruffian on Tue Mar 16, 2010 at 11:07:01 AM EST

that has to be the worst analogy I've heard yet.

Can we not imply that Yglesias is a reporter? (none / 0) (#37)
by lambert on Tue Mar 16, 2010 at 03:06:10 PM EST

Gawd knows most of those called "reporters" aren't either, but please, let's not use the same word for Walter Pincus or Seymour Hersh, say, and for Yggles.

The Obama et al spin will be it's Historic! -- so (none / 0) (#60)
by jawbone on Wed Mar 17, 2010 at 04:17:36 PM EST

there will seem to be no need to revisit the issue for a generation or so. Maybe generations if the Supreme 5's decision to let corporate money flow unhindered into politics stands. (And who's going to gainsay them? Dennis Kucinich?)

The spin will last long enough to bleed the people dry and leave them gasping. Those who make mega money off the BHIP-PPP (Big Health Industry Players Profit Protection Plan) will retire behind the walls of their gated communities and say everything is peachy keen, what's the matter with you whining proles?

STFU and HUAD. The first you recognize, the second is Hurry Up and Die.