What was the best thing to come out of the healthcare bill?

Posted on March 28th, 2010 in Culture,General,Health by Robert Miller

By the time the healthcare bill was signed into law on March 23, 2010 as the “Patient Protection and Affordable Care Act” it looked like a bill designed by Republicans, at least the Republicans we used to know way back when Richard Nixon was President. Indeed, those Republicans might have dreamed about passing such a bill:  for starters, private health insurance companies have been preserved and given millions of new enrollees in exchange for concessions about prior conditions and other issues they should never have been allowed to impose in the first place. Health care stocks went up when the bill passed, in anticipation of the new gains expected for health insurance companies. And, in the last few weeks there was hardly a mention of the public option, something for which the American public has been consistently in favor by 6 out of 10.

After the Massachusetts election, it looked like the Democrats might fold their tent, but even in that state,  the polls showed, on the eve of Brown’s election, that the voters  favored the public option. More savvy politicians realized that the Massachusetts disaster for the Democrats was created because Congress was doing too little, not too much. If there was a revolt, it was against the Democrats for being too soft with their legislation, too poky in getting things done and giving away too much to corporate interests and Republican opposition. Obama was not getting high marks either, as he seemed to be aloof from the debate and one could only wonder if he truly had a passion for one outcome over another. No one knew if he really stood for something.  Rahm Emanuel, White House Chief of Staff, was advising that perhaps they had aimed too high and should lower their sights a bit and  simplify the bill.

But the dynamic for the legislation began to change once talk of a Senate reconciliation process surfaced and, more importantly perhaps, when Obama held his health care summit on February 25th. For me, that was the day that the lion stepped out of his den. It was the game changer.  If you missed it, you can see the whole thing on C-Span, though you probably need to be some kind of wonk lover to sit through the entire day’s event (yes, I stayed home and caught most of it). You will learn something about the bill and you will see how inept the Republican response was and inescapably conclude that their mission was to destroy, not replace (for example does anyone believe that our entire healthcare nightmare will disappear if we impose tort reform?)  It was that one-day summit, very inadequately covered by the press (who completely missed conveying Obama’s grasp of the strategy and the details of the bill and his mastery of the debate), in which Obama embarrassed the Republicans who tried to stand up to him, as he skillfully co-opted any seemingly meritorious suggestions they had (like tort reform, and medicare fraud, which were advanced by some Republicans as the entire reason for runaway healthcare costs; Senator Dick Durbin promptly refuted the idea on tort reform, though it seemed to surface again, because Republicans don’t have any new ideas (tort costs represent less than 1% of the healthcare budget). Republicans were caught flat-footed because they cannot think on their feet, since their ideology and dialogue come from consulting firms, with the talking points for healthcare agreed upon before any healthcare bill was proposed last year. The Republicans will now have to check in for a rhetoric and narrative overhaul at their nearest consulting station. This should be a banner year for consulting firms who cater to the needs of the Republican Party. As a result of the summit meeting, Republican opposition to the bill was much harder to justify, having been smashed during the long meeting, and it also meant that Republicans might have a much harder time explaining their opposition to the bill when confronted by their constituents in the voting booths this fall, especially when the opposing candidate can talk about removing some of the fear out of healthcare risks.   Obama brought out his passion and frustration with Republicans all on the same day. As a policy wonk, he outmaneuvered and flummoxed the Republican opposition. At the end of the summit, it was clear (at least to me) that a bill was going to pass and did so about a month later. It was also clear that day, that Obama had changed everybody’s score card.

After the summit meeting,  focus quickly switched to the House, which passed the historic bill, while the Senate anticlimactically passed the reconciliation bill  a few days later. In retrospect, it all took place with the snap of Obama’s fingers. One can only hope that Obama himself has learned that when he leads, many follow and perhaps he has learned that he’s been too conservative and cautious about having “bipartisan” agreements. Such agreements only weaken the legislation, needlessly prolong the debate and fall into the hands of the Republican opposition, whose objective is to delay, obstruct and kill the Obama Presidency. Many Republicans thought that they had a good chance of killing the healthcare bill as of just a few weeks ago, but now at least one Senator who voted against the bill (Charles Grassley) is claiming he was one of its sponsors. Like the Healthcare bill of March 23, 2010, the Social Security Act was signed by Franklin Roosevelt on August 14, 1935. Although Howard Dean reported that Social Security was passed without Republican Support, more detailed analysis indicates that some Republicans did vote for Social Security (there weren’t too many around then). The two threats against Social Security were mounted by Newt Gingrich with his contract with America and GW Bush with his privatization plan, both of which failed. It appears that of the great momentous social programs enacted into law, the Patient Protection and Affordable Car Act of 2010 is the only one which passed without a single Republican vote.

In many ways the healthcare summit was Obama’s first day as President in the sun. He lived up to expectations and, though hardly a progressive, he stared down the Republican opposition and made them seem like policy wimps–they seemed to complain about the size of the bill because they didn’t want to read it and apparently most of them didn’t. Not a single Republican brought up any issue of substance, outside of the often incorrect talking points they have been using for the past year and all complained about cost, while at the same time being forced to acknowledge that the standard for evaluating the expense of the program was the Congressional Budget Office (CBO) which cited net savings for the plan– it’s their organization. Of equal importance is the fact that within the new healthcare bill, a “Comparative Effectiveness Research” group has been established as a non-profit study group to analyze comparisons for therapy and diagnosis with an eye towards beneficial outcomes. For example, right now there are two different treatments available for the wet form of Age-Related Macular Degeneration, each of which seems to offer equivalent, beneficial outcomes, but for very different costs to the patient.  This group will be responsible for determining the most cost-effective approach based on outcomes. If the two drugs give equivalent outcomes, then strong recommendation will favor the less expensive procedure. This objective strategy offers great reform possibilities, especially as we are beginning to see a whole new host of therapies becoming available and it will take sound judgment to decide which among them is best and most cost-effective. This is a force we have never had before in medicine. It will hopefully lead us into a new era in health care cost controls. We are finally entering the dawn of “molecular medicine.” By the way, the Republicans are complaining about the cuts in Medicare, but that will only happen to those on the “Medicare Advantage” plan, which is the privatized form of Medicare, whose costs are at least 14% higher (many experts have suggested the increase in costs by Medicare Advantage have been much higher than 14%)  than traditional Medicare, with no evidence for improved outcomes. That’s the only part of Medicare that will be scaled back, but of course it’s the one that lots of Republicans prefer.

If you are interested in watching a summary of the new healthcare bill, I suggest you view Judy Feder’s excellent presentation on C-Span or go to the Kaiser Family Foundation site which has numerous explanatory sections describing features of the healthcare bill and an excellent pdf available that summarizes the main changes.

For me personally, the healthcare bill was a major disappointment. I have always felt that we must have a nationalized form of  health insurance that is separated from our jobs. That will enhance our personal security about healthcare and eliminate the employer costs which make our manufactured good more expensive and less competitive abroad. The single payer plan was not given any play because of the high level of  corporate money in politics. Before we can truly address the kinds of reforms we need to right our listing ship, we will need campaign finance reform, which right now is facing problems with the Supreme Court, the balance of which has turned to a Civil War era “state’s rights” mentality.

But, despite my disappointment with the healthcare bill, it does fix many things that were not just wrong, but perfectly odious; our healthcare system had become a sinister corporate operation. Some of that will change immediately. I am in hopes that the insurance exchange system, when put into place, will eventually give individuals better insurance options, though it’s unlikely to compete with the more perfect, single payer system that was never seriously under consideration. Nevertheless, perhaps it could serve as the Trojan Horse for eventually bringing in a national healthcare system or “Medicare for All.”

Now the Democrats can run this fall by talking about the ~44,000 lives their bill will save each year when fully implemented and they can hold their heads a little higher by talking about the first major progressive legislation to come along in more than forty years! What I hope we have witnessed is more than the passage of a single piece of legislation, no matter how historic. I hope and believe we have seen the emergence of a new party climate, one in which Democrats of many different stripes can formulate sensible legislation, present it coherently to the public and, with Obama as a President (who hopefully has discovered the power of his leadership), learn to focus more clearly on the next important task that must be immediately addressed–that of building a new economy. Perhaps we have seen the birth of a new source of national energy for the kind of change that got Obama elected in the first place. We have not seen anything like this healthcare bill in Washington for many decades. Maybe we are learning that government can work. One thing is certain: the Republicans were rightfully scared out of their wits about this bill, because they understand from historic behavior that legislation which brings benefits and a sense of social justice are prized by the public and become part of the national mantra of our expectations. It worked all during the New Deal and we can make it work more effectively again by drawing on our successes, buttressed by the fact that the young millennial generation behind us is one of the most liberal-minded and pragmatic generations in our history. We are witnessing the cultural wars beginning to come to an end, even though tea baggers may keep the issues alive for many years. How utterly boring were they and how much did they degrade the fabric of our country? These wars of abortion, gay rights, the drug war and “zero tolerance”  may not be over immediately, but the odds for a better outcome have been dramatically improved. The groups that support these button issues are diminishing in size and influence. So the best thing about the healthcare was perhaps, just maybe the Democrats got their groove back.

My enthusiasm for the future of this country has been stirred by the events of the last two years in which forces that serve the common public good seem to be emerging from a long Rip Van Winkle sleep under a tree that started to rot. And my enthusiasm has surged further by the behavior of our government since the healthcare summit less than two months ago. Yet, there have been highs and lows over the past year and one might have hoped for better outcomes in almost every endeavor we have witnessed on the political landscape. But fear of Republicans is waning and we should all try to accelerate the growth of the absurd tea baggers, who, together with Rush Limbaugh and Glenn Beck, have placed the Republican Party on a calm sea without rudder or compass. Hopefully, they will finally see the ice flows. What these people represent is nothing less than the re-awakening of Jim Crow, without the realization of what he has historically represented or who in fact he really was. Glenn Beck might try to look him up in the phone book. In the meantime, sweet dreams America–you have to wake up tomorrow with a new vision. That’s the pace of modern life, especially when you also have the future health of the planet to worry about.


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