Wednesday, July 22, 2009

Health Care: A Showdown-Like Thing Approaches

It's been an interesting day in the health care reform effort. Apparently, Speaker of the House Nancy Pelosi may cancel Congress's summer vacation if they don't deliver a bill soon:

Asked at a press conference whether she'd support keeping the House of Representatives in session into the August recess to complete work on health care reform, Speaker Nancy Pelosi was fairly adamant.

"I think 70 percent of the American people would want that," she said. "I want a bill."

Pelosi 'Wants A Bill,' Congress Should Work Through Recess

That sounds more like a hint than a stern warning, but it remains to be seen. The article went on to say that Pelosi sounded confident that she had the votes to pass a bill. What that bill might look like is another question altogether. As I mentioned yesterday, there's quite a bit not to like about the bill as it's currently understood. It will leave millions of people uninsured, and will almost certainly require everyone to buy health insurance. I think that if that requirement is levied without substantially changing the health insurance options available to Americans, it will backfire.

The Massachusetts health care system, widely regarded as an example of how to provide universal coverage and keep costs low, is in fact faltering badly and should not be held up as a national model for reform, according to a study released this week by Physicians for a National Health Program (PNHP) and Public Citizen.

The study comes at a time when the health insurance industry is reportedly weighing in heavily in secret talks on Capitol Hill in favor of an individual mandate, a legal obligation requiring persons to have or to buy health insurance. The insurance industry’s position was described in today’s New York Times.

However, such mandates - which have been a cornerstone of the Massachusetts health reform - have failed to assure universal coverage, the new study says. For example, the state’s most recent figures show that it had to exempt 79,000 residents from the mandate in 2007 because they could not afford to buy insurance.

The Massachusetts plan has also failed to make health care sufficiently affordable or to control costs, the report says.

Physicians, public interest group urge Sen. Kennedy to introduce single-payer legislation

Anyone who is surprised by this needs to review how the advent of no-fault auto insurance, which mandates that all residents who drive have automobile insurance, has affected the quality and price of auto insurance.

Ensuring access to health care for Americans is a problem that's just going to become more urgent and expensive over time. Huffington Post's Sam Stein explains why:

A survey of more than 29,000 individuals in June by Gallup shows that 16 percent of Americans over the age of 18 are currently without health insurance. That number reflects what the survey's authors describe as a "small but measurable uptick in the percentage of uninsured adults."

Crisis: Nearly Five Million Adults Have Lost Insurance Since Sept. '08

For those who aren't good with fractions, 16 percent is about one sixth of the adult population of this country. Considering that a roughly equal number are insured, but are not covered adequately, this is a problem for roughly one third of the country, and that proportion is growing. Failing on this will be a blot on the Democrats' record no matter what else they do in the next year and a half. As we've noted so far, they haven't done very much yet.

So President Obama is going on TV tonight to try to frame the debate more to the liking of those who want to see this system fixed. How successful that will be is a very important one, not only for us but for Obama as well.

Peter Doao wrote this today about the idea that the success of Barack Obama's presidency hangs on how this bill turns out:

The New York Times blares: In Health Care Fight, Defining Moment Nears for President. It's the "Waterloo" talking point, promulgated by Republicans, seized upon by the White House, and echoed by the punditocracy and online commentariat.

It's false.

Some form of health care reform may pass -- the contours may or may not be in place by the August recess (a deadline that has become a distraction rather than an impetus). Stakeholders across the health spectrum may or may not like the final compromise. Pollsters and pundits and press may or may not express approval. But either way, this is not the defining moment or issue of Obama's presidency.

There will be many more watersheds, many unforeseen events, many highs and lows, many poll dips and spikes. In the end, Barack Obama's presidency will be defined by the extent to which he attempts to right America's (badly adrift) moral ship. Providing universal quality affordable health care is only a part of that process, albeit a significant one.

Obama's Presidency Will Not Be Defined by Health Reform (The "Waterloo" Myth)

This will no doubt come as news for Mr. Daou, but for those of us who don't have health insurance, and those of us who are worried that our health insurance won't actually pay to keep us healthy, the "moral ship" of this country is a distinctly minor concern. People are dying for lack of health care in this country by the tens of thousands. For those without family or lifelong friends, there is no safety net anymore.

In addition, as I've already mentioned, this Democratic leadership has done nothing else of note so far. The stimulus bill they put together is completely inadequate to the task of getting this country back on track economically. They were pantsed by the bankers multiple times, and actually had the chutzpah to say that they'd been successful. They haven't done a damn thing about Guantanamo or the other black sites, and they don't seem inclined to move out of Iraq any time soon. They've gradually pissed away whatever good will they had going into this congressional session. These are the things that matter, or at least will matter, to ordinary Americans. The health of the economy and our own health are two things nearly all of us are concerned about, and right now things aren't looking too good. They have managed, to quote Scorpius, to make their vector for success vanishingly small. In short, if they don't produce a decent health care bill, there's not much else they can do that's going to impress their voters.

Taylor Marsh sums up the other problem pretty well here:

Whether its secret meetings with health care industry honchos, or the missteps on marketing health care out of the White House, the debate on universal health care has the potential to become THE symbol of the Obama presidency. And not in a good way.

Pres. Obama came in with record approval numbers here and across the world. His outreach to the world, but particularly the Muslim world, has been greeted with unanimous praise and hope. But at a time when the American people, in a large plurality, have weighed in that they want universal health care, Obama has allowed the naysayers to hijack, not only the debate, but the positive impact of national health care, even when the numbers began strongly on his side. Slowly, we’ve seen these numbers erode. Why? Because the White House naively thought their bipartisan call would be greeted warmly and that Barack Obama would become the political exception to the rule of national politics.

So, the health care debate could become a symbol of Barack Obama’s presidency and how even the mighty can fall, if the opposition, including some in his own party, come at him hard enough.
The “Waterloo myth,” as Peter cites, isn’t a myth at all right now. The symbol has been hoisted. It all depends what happens on health care. Unfortunately, even if Obama succeeds, the seeds have been planted that his health care reform isn’t the best prescription, which means Obama’s health care reform could become the rallying cry for 2010 and beyond.

If that’s not defining Obama’s presidency by health care reform, I don’t know what is.

Health Care a Symbol of Worse to Come if Obama Fails

Sometimes, I think that image and appearances are 90% of politics. They aren't really, and goodness knows they shouldn't be, but they're very powerful nonetheless. The health care reform issue is a perfect example of the failure of the Obama Administration and the Democratic leaders in Congress to deal with what's ailing this country. They didn't turn to progressive organizations, particularly the blogs until a couple of days ago - long after things started going south, and long after the decisions had been made. They managed to honk off many of us by not even considering single payer health insurance as an option. It's possible that, in the end, we would have had to abandon that idea for now, but at least having the discussion would have let everyone have their say, and would have served to give advocates of single payer some ownership of whatever legislation ended up coming to the floors of Congress.

What's worse, they let the message about reform get hijacked by the insurance industry and their sycophants in the news and in Congress. Instead of saying what they were trying to accomplish and how, they let their opponents define it for them. Needless to say, that hasn't gone well for our side.

The irony, of course, is that if they do manage to get this right, Obama and the Democrats could probably coast for the next year and a half. They would have done something that would be directly beneficial to tens of millions of voters. Every time those voters saw a doctor, or were treated for an ailment they used to have to ignore or live with, they would be reminded of what was accomplished. There are certainly people like me who will remember all the other things that they failed to do, but to say we'd be in the minority is an epic understatement. People vote their pocketbooks, and anything that's related.

As Daou mentions, there's much that can change in the next eighteen months, but there is probably as much that can change in the Republicans' favor as the Democrats. If I were the latter, I'd be worried right now. And I'd be asking Rep. Pelosi where you can get a good mai tai in DC.

UPDATE: The transcript of President Obama's news conference isn't an especially inspiring read. He makes some good points about what needs to be done, but even in print it looks like he was phoning it in. Taylor Marsh watched the conference, and that seems to be her impression, also. As both she and FireDogLake mentioned, he has started calling this "health insurance reform", which is a more honest label. It's mostly about how we pay for medical care, not the care itself.

Anyway, certainly not a knockout punch, and maybe not more than a slap. This is going to be a long battle, and I'm not terribly confident that it will feel like a victory at the end.

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