Thursday, October 08, 2009

This sounds promising for the country but not so much for us

Healthcare reform is finally creaking forward in the Senate. The CBO score on the Baucus bill should pretty much guarantee that the thing is going to finally get out of the finance committee.

Senator Schumer has been leading the charge to rally Democratic colleagues to support sort of public option once the Baucus bill is married to the one that emerged from the HELP committee.

On that front, it appears that a compromise is in the works that seems like it could win the support of blue dog Senators without alienating progressive votes.

The bill would include a national public option healthcare plan, which I think, is a major victory.

But it would also allow individual states to opt out, to prohibit its citizens from choosing the public option.

Now for most of the country, this is a great deal.

For people in Louisiana and elsewhere in the Deep South this might not be so great.

Though I think the politics of denying Louisiana residents the opportunity to participate in a national program like the public option is quite a bit more difficult than halting the creation of the program in the first place, I don't think there will be a shortage of ultraconservative politicos willing to roll the dice.

It also exposes what I consider to be the central challenge to progressive politics in the United States. To what extent can the Democratic Party and the loose progressive coalition that brought it back to power continue to throw overboard minority, poor, and working class families of the South and other ultraconservative areas when it comes to enacting policies that poor and working class families in conservative districts and states need more than anybody else?

If families and individuals from Louisiana, perhaps the state with the absolute worst healthcare outcomes of all, can't take a crack at a national public option program because of ridiculous GOP intransigence and Democratic cowardice, it would be tragic.

Still, I think the right thing to do is to swallow hard, embrace this sort of compromise for the good of the country, and take our chances fighting any state politicians that want to deny Louisiana residents the right to choose the public option.

What say you?


Anonymous said...

Check out this health care summary from the back of the napkin author - it's a very easy powerpoint.

It's a good high level view of where we are at in the debate and then people should take it upon themselves to learn more.

E said...

I endorse that link.

Clancy DuBos said...

I'm totally speculating here, but something tells me there's a foot-in-the-door strategy behind the "opt out" plan. Letting states opt out (for now) is the foot-in-the-door. In a year or two or five, Congress could enact legislation similar to seatbelt laws and interstate speed limits; i.e., allow states to "opt out" -- but only if they're willing to do without federal funds on other levels ... say, Medicaid?
Just a thought. It's basically a delayed delivery of the public option, which may be the best deal Obama can cut right now.
Again, I'm speculating...but this scenario has a familiar ring. We'll see.

Stephen said...

I think what you are missing is the positive impact expansion of Medicaid eligibility will have on Louisiana, probably more so than any other state. We are very stingy with Medicaid eligibility, with the result that the majority of the state's current uninsured will become insured through Medicaid, under all of the 5 proposals. No other state will be as positively affected by this one change. That's huge, for many reasons, not the least of which is that total reliance on the Charity Hospital system will end.

G-FUNK said...

Why does this bill start collecting revenues in 2010 but the services not go in effect til 2013????

I think we all know the answer (2012 presidential election, CBO budget score stops in 2020)

God help us all if by the year 2030, when I'm hitting 50 and health is a concern, that I am forced into government run healthcare when I've busted my ASS my whole life to deserve much, much better.

Papa Bear said...

according to G-Funk, VA/Medicare/TRICARE is worse then private insurance.

E said...

G-Funk has been on a roll.

E said...

I actually disagree with Clancy that the main strategy here is foot-in-the-door. The first calculation is to negotiate something that can pass, obviously. The second calculation, when you start to consider the consequences of the deal, is that conservative states would have a harder time than they think getting constituents to support opting out of a program that pretty much every other American is going to have the CHOICE to join, especially as citizens of neighboring states get to join.

Opting out of the right to enroll in an accepted public option program is going to be a lot tougher than screaming to try to kill the creation of a new program.

I'd bet that if a bill passed into law with an opt-out clause, only 4 or 5 states would try to actually deny their citizens access to the program. Maybe only South Carolina and Louisiana would actually try to do it.

I don't think the federal government would have much interest in forcing it through attaching strings to funding. They're more likely just banking that ultimately citizens of those rogue states would want the same option every other American has once it is clear that it's not hellfire and brimstone.

I think foot-in-the-door implementation using something like the federal highway funding carrot better applies to other Senate compromise proposals that have had various degrees of success: a really watered down public option, an opt-in public option, or Wyden's proposal on state laboratories.

Stephen is also right that it wouldn't be all for nothing if Louisiana or a few other states do end up opting out of the public option for some reason. It would still mean some pretty sweet reforms. That is why it is pretty clear that out of all the compromises out there, this is one I'm willing to support, perhaps with enthusiasm.

Clearly, there is a lot to work out and I imagine that some major complications will arise as rules for opt-out are negotiated and how federal reimbursement streams navigate around states that act on national standards, etc. Those complications might even make this whole thread moot.

But this idea coupled with the CBO score on Baucus' bill, have given this some real momentum... finally!

G-FUNK said...

Speechwriter for Obama/Edwards/Clinton can't get insurance in Massachusets, aka the Nirvana of government managed health insurance.

Why do you folk put your faith & hope in our government, which over and over and over again has proven incompetent, no matter which party is in charge???

E said...

I do indeed believe that the greatest country in the world is capable of setting up a functioning bureaucracy. I think we have lots of them already. I believe in the missions of many executive departments and federal programs and think that there are many executive departments and federal programs that are administered reasonably well. I'm thinking of social security, medicare, the va, the military, etc.

I think also think that in recent memory, Republicans have proven far more incompetent at managing bureaucracies than Democrats. FEMA is a good example of a federal bureaucracy that used to work quite well before President Bush II. The FDA, the EPA. and the Department of Justice are others.

So yes, I think we're smart enough to competently establish and manage an optional national healthcare program. Other countries have proven far more demanding programs can be administered quite effectively.

G-FUNK said...

E - social security and medicare are going broke.

I wish I were as idealistic & nieve as you...I guess working in the real world will take that away from a man.

Papa Bear said...

Medicare going broke is directly related to the stress that our current health care system places on it. Due to the inability for many Americans to afford insurance (or even worse pay for insurance they will never really be able to use), most people forgo checkups, deal with pain, etc.

62 is the age when a number of Americans finally get checkups, after 30-40 years of little to no access to preventative care. The current MediCare system works when citizens have access to preventative care in their 20s-60s. If not, the system becomes financially stressed until we have the current problems.