ELDER GEEK: Playing With Boxes
REFLECTIONS: On a Holy Night

Reasons to Support the Senate Health Care Bill

category_bug_politics.gif I was surprised at the anger and bitterness in the some of the comments on Monday's post about the Senate Health Care bill. Is it far less than it should or could have been? You bet.

Am I disappointed that President Obama held himself above the fray during the debate and didn't get his hands dirty twisting arms and horse-trading? Absolutely.

Am I furious with the entire Republican contingent who would rather see people die than give an inch to President Obama on any issue? Without a doubt.

However, in the larger picture, something crucial and good has happened: the idea that health care is a commodity to be mined for the profit of a few has lost ground. The idea that health care can be rationed by the ability to pay is no longer acceptable.

Yes, it is true, for the time-being, that private insurers will gain 30 million customers, but they will be severely restricted now from gouging those customers. So let us look at the broad gains contained in the Senate bill.

Within a few broad categories, everyone will pay the same amount for health coverage.

Medicaid will be significantly expanded.

Subsidies for low- and middle-income workers will keep premiums to under 10 percent of their income.

There are caps on out-of-pocket expenses.

There will be no life-time caps on benefits and annual caps will be restricted.

There are limits on emergency room charges for low-income, uninsured patients.

There are new tax credits to help small businesses purchase coverage.

Insurers must take all comers. No longer can benefits be cut off when people get sick, nor can coverage be denied for age, gender and pre-existing conditions.

That last item deserves a bit of explanation – it involves two issues: denial of coverage and denial of care for pre-existing conditions. Both are banned for children and adults as of 2014 when the exchanges, where people will purchase insurance, go into effect.

A dispensation has been carved out for children who, as soon as a bill is signed into law, cannot be denied CARE for pre-existing conditions. That means if you already have insurance covering a child, a company cannot deny a claim for anything they might now label a pre-existing condition.

Not good enough? True. But better than what we have now.

There is another immediate gain for Medicare beneficiaries. The size of the doughnut hole in prescription drug coverage (Part D) is reduced by $500 for 2010. Additionally, beginning on 1 July 2010, low- and middle-income elders enrolled in Part D programs who fall into the doughnut hole will receive a 50 percent discount on brand-name drugs and biologics.

Not good enough? Yes. But better than 2009.

For a century, during seven different presidential administrations before this one, health care reform has been attempted and failed every time. Given that history, we have made remarkable progress this year. The bill is far from perfect and it will take many years, perhaps a couple of decades, for it to become comprehensive, fair to all and for the private profit system to be deemed unacceptable.

But we have a beginning. Listen to Eugene Robinson writing in the Washington Post yesterday:

“[L]et's consider the measure's one great virtue: For the first time, we will enshrine the principle that all Americans deserve access to medical care regardless of their ability to pay. No longer will it be the policy and practice of our nation to ration health care according to wealth...


At The Elder Storytelling Place today, Johna Ferguson: Winter's Blush


I'll shout favorably when I see the final bill that's sent for the President's signature.

I agree with Joared. And Ronni, I see all of your points but if at least the changes took place within 12 months, I would feel better because then we would have a stepping stone to increasing benefits. This is 4 years away and that is NOT good enough.

During those 4 years another 160,000 will die.

Not good enough

Absolutely, waiting 4 years for most of the benefits to go into effect while collecting the taxes and fees sooner is wrong.

Sorry, Roni, but it's a shell game. So the donut hole will be $500 smaller - for many that's less than one month's drugs. And the 50% business - you can rest assured that drug prices will be increased to compensate. No, this is not the reform that the President promised.

So my question is: should this bill be killed and then we wait another 10, 15, even 20 years before reform is attempted again?

It is an imperfect bill and will remain so when merged with the House bill. But it is a start, a beginning and a precedent is set. If we don't begin now, it will be a generation until we start again.

I suspect that we should ask our Senators to hold their noses and vote for the thing. (Living in Kansas I know that my Senators will hold their noses and vote against!)

Then comes the reconciliation process.

I know what you're saying is probably right and I may have to swallow it...but, I'm simply furious that republicans and Democrats alike can't do something so simple that the majority of the civilized nations have already done. Years ago. The blueprints and the models for good public health care abound, yet these bozos of each party are trying to reinvent the wheel and care not who dies in the process. Sorry, I get so worked up about this my grammar suffers. But darn it, in this case it is NOT rocket science.

I think the bill must be passed, BUT I also think we all need to let our Senators and Representatives know that they have failed in their duty to the people and to their country.

Supposedly Part D was going to be improved - I work closely with it, and it's getting more and more confusing and the insurance companies are taking more advantage of the people. We have to demand better right away.

My faith that it will be improved would have to rest on the Congress usually improving things that they start. I don't see the evidence. IF this ends up a boondoggle (insurance companies are already trying to figure out the loopholes), if it ends up costing the government a lot of money while the insurance companies have increased profits, if it has those exceptions in rates that allow large increases in some categories of people for things that are pretty average like high bp or cholesterol, then the Democrats will suffer in elections and we could see a Republican majority take over again. There is more at stake here than health care if that happens.

The issue is whether this works; and with 2000 pages and a ton of loopholes for special this or that, it has a lot of room to fail.

We have a Congress that even with a 60 vote majority put the interests of the insurance profits 'at least' on a level with the people's. I'd have more faith in their motives if they had allowed citizens to fill prescription drugs online in Canada. That would have saved people money but big pharma fought it and won. To me it's evidence to not trust they will do differently in the future.

I sympathize with those people who don't have insurance right now, wanted a single payer, but I don't think this bill does enough (if anything) to limit corporate profits and what they are allowed to put into expenses before profits are figured could be the kicker).

When working people find they could have to spend 8% of what little money they have on insurance, a lot of them will be trying to figure out where they find that money. It's a tax whether they call it that or not but it just goes to the corporations directly. I do not know the details of this bill but I had questions like if a person is limited to 8% of their income for costs, what is to stop them from buying a more expensive insurance program than they would otherwise have purchased? Does the government pick up the difference in cost? Will all insurance coverage now end up being the same for what it offers?

I don't like the bill and feel that some of the pressure to pass it was to make Obama look good and not give the Republicans a victory that they would be chortling over for months. Those are the reasons we got into the war in Iraq, why we had a tax cut without corresponding cuts in spending. Making a president look good can lead people into terrible messes. I hope this isn't one of them. Right now I think it will be. I very much hope I am wrong.

I agree with Ronni and I hope we Democrats/Liberals don’t end up in a circular firing squad over health care reform. We seem to be good at it.

As Jonathan Alter, Senior Editor at Newsweek and author of The Defining Moment: FDR’s First One Hundred writes—“ FDR didn’t get Social Security until he had been in office for two years and didn’t get everything he wanted the first time. He had to keep going back to Congress to strengthen the bill. A lot of the New Deal types really hated Roosevelt's Social Security plan because they thought it was so weak. And then later they changed it, and they changed it again, and they changed it again. And the lesson here is that you don't want to make the perfect the enemy of the good in health care. You get a bill, and you use it as a foundation to build on for the future. You don't hold out and stamp your foot to get exactly what you want.

“Progressive Democrats in the Senate and House should take heed, making sure to just get reform passed initially, with an eye to strengthening its weaknesses and fixing its flaws when the opportunity to do so is more auspicious in the future.”

And then there is Senator Sherrod Brown, one of our more Progressive Senators, saying, "It's not a great bill, but it's a good bill. It will provide generous subsidies to millions of lower middle class folks who can't currently afford health insurance. It expands Medicaid to cover more of the working poor. It enables hundreds of thousands of people with preexisting conditions to finally get health insurance coverage.

“I really don't understand all the outrage around here. Disappointment, yes. But outrage to the point of burning down the house? It baffles (and scares) me.”

I will continue to hope for a brighter world in 2010.

There probably are many more reasons why the law won't kick into effect for 3-4 years, but the most obvious are these two:
1/ We will need time to train more docs, nurses, etc. to handle the newly insured
2/ It WILL impact on jobs at insurance companies and health care providers, which make up 1/5 of our economy. There will be jobs lost and jobs gained, so it will take some time for those things to shake out. Again, many people will need to be trained or retrained.
All in all, I believe it's a great start. By the time the benefits are in place for patients, we'll have a different Congress and could have a different president (although, I hope not). Those who are so opposed to a public option today may change their minds, when and if the rhetoric dies down.

I depend on you to boil it down for me so I can understand it - and you did a fine job. Thanks, Ronni.

I, like kenju, depend on Ronni and the commenters to understand this....My feelings are very much in line with Steven.

Like Kenju I appreciate your synopsis of the situation. From the beginning this struggle to introduce universal health care has been ridiculously complex and the reporting biased and convoluted. Your summary helps greatly to understand the situation.

As you say, it is a start. Thus it is a success of sorts. The bill is not what it could have been, but it is not the worse case scenario, which would have been failure to pass the bill at all. It is, in the end, a reflection of the strengths and weaknesses of your political system as a whole. You guys are thirty years behind most other countries in social health care, so take a deep breath and know the journey will be long. Even though the successes are hard to win, they are successes none the less.

At least this gives us a stepping stone to build from. It isn't perfect but it is better than the nothing we have had so far.

Yes, thank you everyone for this dialogue. I'm beside myself trying to figure out where I stand in this political firestorm.

I'm reminded of a trust workshop I attended and I think some of those issues of mistrusting the government are at play in this. At least they are for me. I was told, at this seminar, some of us get into the habit of needing to be right above all else (as in this falls WAY short of what I envisioned for American health care) and we forget we are in an ongoing relationship with our country. It steals our fire not to get the ideals we have focused on and hoped for so long but we run the risk of putting the fire out entirely if we don't accept the fact that this is an ongoing issue. We are going to have to keep writing letters for the rest of our lives for new and improved health care reform. Yeah, I wanted it to be a one shot deal now lets move on to the next agenda item but our country isn't that way. In reading Mona's comment I realize it never was. Democracy is a dirty bit of business.

If we kill the bill we could be throwing the baby out with the bathwater and tossing it right on the flames of our good intentions.

I deeply regret that Ted Kennedy didn't live to fight as he tried to for decades...The Republicans "outwaited" him on purpose...

The Senate Sucks!!!

I almost wouldn't read your post today because I am so very disappointed with the bill. The nation had an opportunity to do something great and something that would bring us all together and we allowed divisiveness and fearmongoring to prevail. I suppose something (eventually) is better than nothing but frankly this is a lot closer to nothing than something. IMHO

Many of us are disappointed that the public option didn't get included, but I agree with Ronni that we have to get something. It will take time to become what it should because we have too many greedy people in this country.

Many of us have to face that we had unrealistic expectations because we believed that enormous change was possible. The election of Obama helped us to feel this way--same would have been true if Hillary became president.

I'm ready to go with this one. Listening to my 40 yr old son: it will help those younger than him. And we should never again put the adjective "public" in front of anything we want Americans to buy into. Think public housing, public schools, public toilets. Private is what we move toward.

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