The coming crescendo of health care reform

Posted on October 24th, 2009 in Health,Politics by Robert Miller

Now that all five of the healthcare bills in Congress have come out of their respective committees, dramatic alignments and re-alignments are taking place over the public option. Nancy Pelosi claims to have the votes in the House to pass a public option bill, but what kind of option will that be? Hopefully one strong enough to give every private health insurance company competition for those already signed up through their place of employment. The behavior of the insurance industry over the past week, with their report predicting large premium increases, even with the Baucus plan, has angered Congress; they are now threatening to remove the antitrust immunity that was given to them decades earlier.

Health care benefits are evaporating before our eyes as co-pays increase and benefits dwindle: this is true whether you live in a state that allows for-profit health insurance companies to operate, or one, such as Minnesota, that does not. Physicians who have worked in both for-profit and non-profit companies have told me there is very little difference between the two–it’s just a matter of whether the profits go to shareholders and executives or executives only–a profit motive exists for both kinds of insurance companies and abuse is commonplace.
Only in the state of California do the health insurance companies have to reveal their claims denial rates and in the first six months of this year three of the six largest health insurance companies in California reported 30% denial rates. If people are going to shop for their own health insurance through the new healthcare reform plan, they will surely want to know the denial rates for coverage, something only available in California. In other states they refuse to reveal denial rates. Another bad mark for private insurance companies.
As the anger towards insurance companies grows, on the Senate side, Majority Leader Harry Reid was, at one time, perfectly content to let the Baucus bill become the Gold Standard for the Senate healthcare bill. This meant that, to insure 60 votes to prevent a possible GOP filibuster, he needed Olympia Snowe’s (Maine Senator) vote and, in effect, this meant that she was writing the Senate Healthcare bill. Her preference is the “trigger” mechanism in which a public option would trigger in only if private health insurers failed to insure the majority of Americans. All of us know that such a mechanism will never reach threshold because it will be politically determined and the health insurance companies will learn how to asymptotically approach the trigger threshold without ever reaching it. Snowe is naive about health insurance companies and the power of their lobbying system (or perhaps not). But Snowe has cast some doubt as to her final vote on any bill with a public option; more to the point, she has threatened to filibuster any health care plan that includes a public option. It is unclear what the White House is willing to support, as two interpretations emerged from a meeting this week with Senate leaders. But with Snowe’s announced filibuster threat, the White House seems likely to jump on board a stronger public option plan and many in the Senate are claiming they have 60 votes without Snowe to prevent a filibuster. Olympia Snowe cannot filibuster without at least one Democrat switching over, and, unfortunately, there are several conservative Democrats that are suspect traitors. But, as Howard Dean points out on the Rachel Maddow show, though some conservative Democrats may vote against the bill, it is traditional that party lines are adhered to when dealing with procedural issues. Thus, though only a single Democrat could sink the bill by allowing a filibuster to take place, tradition dictates that such a move would seriously undermine the Democratic Party and its leadership, rendering a severe blow to Harry Reid. Conservative Democrats that are unlikely to vote for a public option bill, have stated that they will not vote for a filibuster. So, right now, today or perhaps yesterday,  it looks as though things are not moving in a direction favorable to the health insurance industry or the Republicans. Olympia Snowe comes from the 40th most populous state and it looks like her supremacy in leading healthcare reform was alive for about one day until she announced she would opt for a filibuster if a public option was part of the bill. Hello and goodbye Olympia and good riddance!

We must not forget that the reason a strong public option has made its way into the conversation is the overwhelming public support for it, expressed through all the write-ins, phone calls, faxes, letters and polls that strongly favor such an option, with or without Republican support.  In Reid’s home state of Nevada, apparently 80% of Democrats favor a public option plan and this is a major reason why he is considering a bill with a strong public option. So, we should add some pressure on Reid by sending him our support for the public option. Should the public option bill be introduced onto the Senate floor, and subsequently passes, the public and the intensity of the public demand, gets the credit. Thus, such a plan seems closer than ever to becoming a reality, but that of course is how it looks today. Who knows about tomorrow? So keep calling, writing, signing petitions, sending emails and hollering from the roof tops. A good public option seems more achievable than ever and if made strong enough, it could lead to an avalanche towards a single payer plan, in which case, we would completely divorce ourselves from employee-based health insurance. That’s the only system that will work in this country and it will create jobs by simplifying and reducing the expense of starting and sustaining small, medium and even very large businesses. One of the greatest threats to small business firms is the cost of health insurance for their employees. And, every year it gets worse. Hopefully, we will soon begin to wake up from a long, healthcare nightmare and, who knows, our actions on healthcare might spillover into other concerns over poverty, equity, education and an affordable college degree. Perhaps we as a nation are finally beginning to realize that we took a bad right turn thirty years ago!


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