Thursday, January 07, 2010

Snapshot of the Debate

Since Wednesday afternoon, over at my Facebook page, several of my friends have commented on a status update I posted addressing the health care reform legislation now in its final stages in the U.S. Congress.

Many of those commenting were from Pennsylvania and New York so it was almost a conversation truly "Between the 'Burgh and the City."

I'm posting the exchange below because it was a lively give-and-take with some good writing. And, for the historical record, it's a snapshot of the debate in these early days of 2010.

All of those commenting are in their 20s and 30s (with one who recently turned 40). I'm going to omit their last names but add their locations.

To begin, here was my status update:

Paul Snatchko thinks the House Democrats are making a mistake by not having a formal conference committee prepare the final health care bill. Health care reform should be carried out in the most transparent, honest and ethical way possible.

Here were the comments in the chronological order:

Adam (Washington, D.C.):

Amen. Alleluia!

Dave (Brooklyn, NY):

Really, the people who are making the mistake are the Obama administration and the Senate. I'm certain the House would totally love to have a conference committee.

Leanne (New York, NY):

Paul. I am going to like having you as a Facebook friend!!!!

Dave (Brooklyn, NY):

It's possible that this is not-so-bad for the actual legislation while being terrible from a process perspective, too. Though I tend to agree that it's a bad move generally.

Margie (New York, NY):

I wish this could be true, but there are many with a different agenda.

Justin (Los Angeles, CA):

I'm so sorry to comment here but you have to appreciate the humor. Paul, your update is sandwiched between two others on my page that read as follows: " ... wonders what color Lady GaGa's pubic hair is" and " ... is covered with her baby's vomit." Thanks for having a brain! :)


You're right, Dave. That should be "Congressional Democrats." Leanne -- thanks! Justin, that made me smile. :-)

Dave (Brooklyn, NY):

The thing is that the House is getting totally rolled because they don't have to achieve a super majority to get anything done. I'm sure Nancy Pelosi is *pissed*.

Paul (Not me, he's in Findlay Township, PA):

The result of the non-existent conference committee will be a couple hundred pages of bribes paid by Pelosi and Reid to individual members of Congress to guarantee their votes on the "final" bill. Because all of those bribes will be scattered throughout the entire 3000+ pages, and they will rush the vote, there will be no way to make all of the bribes publicized. Reid and Pelosi are truly evil people with no souls.

Dave (Brooklyn, NY):

Yeah, because the thing that truly evil people who have no souls try to do when they are in power is ... give ... people ... healthcare.



Paul (Findlay Township, PA):

Dave, if they were actually trying to give people healthcare, you would have a point, but they are only on a power grab, nothing more, nothing less. Do you think that their lack of transparency would be necessary if their motives were pure?

Dave (Brooklyn, NY):

The final bill will probably cover somewhere between 90-95% of the population, meaning it will cover 20-25 million people more than are currently covered now. That's not 'actually trying to give people healthcare'?

And let me just tell you, I do not think that any human being's motives are ever entirely pure, but I do think that even if they WERE trying to only do good, with no regard to how the outcome would affect them, they would face considerable pressure to act without transparency given the (historically rather notable) complete and unbending and uncompromising and indeed rather obstinate opposition of the minority party, which has clearly decided that trying to derail healthcare reform is to its political benefit, without regard to the fact that the healthcare system in this country is a very, very serious problem.

If Republicans had decided to negotiate in good faith on this issue I think the final bill would be a much more conservative document. As it is, they made a gambit that they could kill it entirely by refusing to work together with the elected legislative majorities and administration - a gambit which may yet pan out, by the way - and the result is a process that has taken nearly a year. There are clearly a lot of other pressing issues for the government to take up, and it's also clear that Republicans intend to delay this process at every step. Given that the key legislators involved don't want further delays, and want to see a bill expanding access to healthcare passed (which is a fact that I don't think should really be in question), and given that further transparency will most likely delay the bill even further and make passage even less likely, I can see reasons why they're doing what they're doing that are not 'power grabs.'

Lou (McDonald, PA):

I usually don't comment too much about issues like this, but thought I would throw my two cents in. What upsets me the most about this plan is 1) how the deciding senate votes were basically bought. That was so blatant, it made me sick and made me wonder why Casey and Specter didn't bargain for anything for PA. 2) Working for a small employer (under 25 total employees) they have the right to opt out of providing health care benefits for us. This potentially is going to take away a bargaining issue at contract time for us. I highly doubt they will increase our pay the amount that they will save. 3) Under this plan, we currently have what is labeled as a "Cadillac" plan. Now what may seem excessive to some, took us a while to negotiate and fight for. If they don't take it away for reason 2 then they can use this. 4) Public money for abortion is so wrong. 5) Finally, if this coverage is so great, why are the president, vice president, senate, house and supreme court exempt from it???

I agree that there are flaws in the system, but most people I know and talk to are dead set against this. That makes me wonder is this really what the people want or just a case of government thinking it knows what is best for us?

Of interest should be this too. My wife works at a Catholic hospital that was recently bought up by the monopoly that is UPMC. What is funny is that they still accept everyone regardless of insurance or not and treat them, most of the time never getting paid. Even funnier is when an uninsured becomes stable at a different hospital, they are sent there knowing that they will receive all the care they need without questions. It seems that the big money health care providers are more to blame than anyone else.

John (Westchester County, NY):

Like they say, "You get what you pay for."

Kara (Yonkers, NY):

You actually *want* your health care in the hands of the Fed? Why? Do you honestly believe and trust that the quality of and access to health care is not going to change? With 50 million more people in the system and no increase in physicians (take a look at Massachusetts...people don't want to become doctors if the State/Fed takes over, because they don't get paid nearly as much), there will be rationing of care.

Also, physicians who approve a treatment that the government deems unnecessary will be docked 5%. What does this mean? Dr. Smith gets less money if he sends Grandma for the operation that Barry O. doesn't deem necessary. What does that mean? Think about it. It is absolutely terrifying.

Why can't the government simply create a much smaller program to cater to the truly uninsured? Why does it have to be all or nothing? I *want* to pay for my own private health care, and I don't want to be fined [which I would be as the plan stands right now] for not participating in a government system - that I would be paying for anyway via taxes and not using!

The most disgusting part is that the very people creating this nightmare are not going to have to use the system they're forcing on the rest of us. If Nancy Pelosi and co. were forced to use the government-run substandard health care that the masses will have to accept, this whole circus would have never been started. What's good enough for regular Americans is not good enough for Harry Reid.

Bibianna (Teaneck, NJ):

Politician and "transparent, honest and ethical way possible" seem very unreal!!!

Kelly (Cecil Township, PA):

I heart Kara. Whoever you are. I. Love. You.

Amanda (Pittsburgh, PA):

And I have real love for you, Dave (whoever you are).

Paul (Findlay Township, PA):

Dave, when you say that the Republicans haven't negotiated in good faith, you are suggesting that the Democrats have given them the opportunity to do so. The Republicans tried time and time again to offer amendments to allow insurance companies to sell policies across state lines to increase competition as well as other market-based reforms that would allow competition and cost nothing at all to the taxpayer. The Democrats have shut them down completely at every turn. They did not invite the Republicans to any of the negotiation meetings at the White House, despite promises early in the process to do exactly that.

Bottom line - the Democrats have complete control of the process because of their filibuster proof majority, yet they had to buy off Ben Nelson and Mary Landrieu, among others, with provisions in the bill that can only be described as bribery.


Myself, I'm really hoping the special deals for Nebraska, etc. are taken out of the final bill -- because they taint the reform effort.

Lou, regarding the taxing of the "Cadillac" plans to help fund insurance for others, do we know the dollar amount for that yet? My impression was that only plans that cost around $200,000 a year or so were going to be taxed (or at least in that ballpark) -- the kind for your corporate execs, etc. I could be wrong though.

As to the overall question, I have to say I'm conflicted.

Today, I have quite good health insurance that my company provides at no cost to me at all. (I would have to pay if I wanted to add a spouse or children.)

But, earlier in my professional life, I spent several years without healthcare -- ironically when I was a Republican political operative. I simply could not afford it. So, I know how scary and financially dangerous that is. But, it's a choice I made for my career.

But, I'm also worried about the ability of the federal government to pull this off in a way that doesn't worsen our current healthcare system -- or cause greater harm to the economy.

There's another question here, though. It's the more basic values question -- do human beings have a right to health insurance? In a modern society, should a nation guarantee all of its citizens health insurance?

Most of the other Western nations do that -- and it generally works. As Kara correctly pointed out, doctors and nurses make lower salaries. There are waits and other problems. But, the health care systems of Germany, Switzerland, Japan and Taiwan all generally work -- but they are seeing problems on the horizon in rising costs.

I don't know. Still thinking ...

Thanks to all of you for this exchange, today! I love all of you.

Dave (Brooklyn, NY):

Paul, the Gang of Six included three Republicans (including two fairly conservative Republicans) and they could have had a real hand in shaping health reform. Chuck Grassley in particular very clearly participated only up to the point that he could (he seems to have hoped) throw the whole process under the bus. The Gang of Six were the central actors in health reform in the Senate (and thus really in the process, because if you think that the White House is driving this bus you have been more impressed by their effort than I have) for months, but nothing came of it because (I believe it is pretty clear) Chuck Grassley and Mike Enzi decided not to play.

Selling insurance policies across state lines would gut the current way that insurance companies are currently regulated, and it falls under the 'pipe dream' category of reforms supported by partisans much like, say, single-payer does. It was never going to be part of a compromise. But, for example, tort reforms might have been included in a more bipartisan bill. The Republicans just decided (and really, they had decided long ago) that there was more political upside, potentially, in defeating any reform rather than playing along. I'm not actually sure they were wrong to do that! But losing any possible Republican support does mean that the ultimate bill is going to be liberal.

I'm clearly more involved in the political discussion than the policy discussion in this thread, so I'm not going to address a lot of the talking points people have thrown at me (except to say that it's very clear that though the Federal government is intervening in the healthcare system by making laws, which is entirely appropriate, the vast majority of the healthcare system will continue to be administered by private companies, so I don't know why people keep talking about the Federal government taking over the healthcare system).

But I do want to say, to Lou, that I think your objections are the most heartfelt and fair that I've encountered of any opposing voice in this debate. And I'm pretty sure that whatever does eventually pass will prevent federal funding of abortion, because that's the only way anything gets past Ben Nelson. See, having Senators in strategically pivotal roles who make deals to serve their constituencies is not always bad, if you are part of their constituency (as people opposed to abortion are most definitely one of Ben Nelson's key constituencies).

Addendum: Here is an article about the proposal to tax the "Cadillac" plans.


Isaac Bickerstaff said...

This is a response to Kara:

There is a difference between health care delivery and payment. Insurance companies pay for health care, and doctors, hospitals, pharmacies, etc. deliver it. Insurance works best when the most possible people pay into the pool. It spreads the costs so everyone's premiums are lower, but the insurer can afford to pay out more. This is all very simple economics that everyone with the exception of some ideological zealots agrees on. Your argument is invalid because you confuse delivery and payment. An insurance program like Medicaid/Medicare is paid for by the government, but provided by private hospitals. Most everyone who has M/M agrees it's a godsend. The current health care bill doesn't even go that far. It simply aggregates and regulates private insurance companies. The "conservative" reaction to this debate has been visceral. People hate it because they vaguely hate the government (except when it's ginning up a war, or inflating an investment bubble, or redistributing money from the poor to the rich -- that is, when the redneck moron they can identify with is in office) not because they understand the mechanics of health care or government. As you just proved.

Paul said...

Dear "Isaac,"

Thanks for your comment. I give you points for creativity:

All the Best,