Think About It Really, Really Hard

Caption: The Thinker. Rodin's ironic work seems somehow appropriate here.

Image credit: CJ/Wikimedia Commons

It's appalling how divorced from reality the debate on health care has become. There is this idea that somehow the Senate bill will be fixed later, and that the House should just pass it so that we can continue to have momentum. Nate Silver thinks that a bunch of little attaboys is worth more than a few huge "aw shits" when it comes to the features of the Senate bill. One blogger seems to think that not passing this bill is a sign of lack of courage. Steve Benen thinks that the House just has to trust the Senate to fix things later. I think passing it shows a sign of a lack of a functioning brain. Here's why, via Jon Walker:

According to Politico, the potential reconciliation measure contains six major components:

1. An increase in the Medicare payroll tax for the rich
2. More cuts to Medicare Advantage
3. The special excise tax deal for unions
4. Small increases in affordability tax credits
5. A fix for the Nebraska Medicaid deal
6. Closing the Medicare Part D donut hole by 2019

There will also be some other small, technical fixes and, ideally, a national exchange instead of state-based exchanges. The national exchange could easily run afoul of the Byrd rule, and might not be possible.

Tax Increases, Medicare Cuts, And Special Give-Aways To Unions: Are Democrats Actively Trying To Lose The House?

Do you see a public option in there? Do you see any way of enforcing all those marvelous insurance regulations that are supposed to make insurance so much fairer (in other words, many of Nate's "attaboys")? Do you see any added funding for Medicaid, so the burden of increased qualification doesn't fall on cash-strapped states? See anything about allowing drug purchases from Canada?

I don't either.

This is the plain truth about the Senate bill - it sucks. It cannot be fixed without utterly changing what it is. It was written by people who are completely compromised, and passed by people who will not have to deal with its effects. The House bill may be redeemable, but that's "off the table".

There will be no health care bill worth passing.

Ian Welsh's first rules of thumb for thinking is "don't trust liars." That seems like such a fundamentally simple thing that it's barely worth mentioning. I never would have thought to. Yet people seem to think that you can trust liars when they are saying what you want to hear. You can only trust liars when they have no choice but to do what they say, and even then, only if they are smart enough to know what they can't do. The Senate leadership lied when it said it needed sixty votes to pass a health care bill. They lied when they said they couldn't get sixty votes. Trusting the Senate to fix things is absurd on that basis alone.

It's also quite apparent that none of these people is thinking about what happens after the bill is passed and signed. How will the insurance "reforms" be enforced? There will be hundreds of thousands, maybe millions, of complaints annually. Many of them will be valid, and some will not. Just sorting through those complaints will take hundreds of man-years. Does anyone think there's a federal law enforcement agency that can deal with that additional load without funding? Does anyone really think that in a thousand-plus page bill they just forgot about enforcement? If you think either of those things, or didn't think about it at all, count yourself as someone whose opinion on this matter isn't worth listening to.

I still have yet to encounter an intelligent answer to those issues.

We should get used to the idea that no health care reform worth passing will emerge from this session. Before that can happen, we need to change Congress. Until the current herd of prostitutes is thinned, nothing better will ever come of this process.

UPDATE: Added some evidence for why I wrote that the Senate leadership are liars. Memories can be conveniently short, and I should know better than to let those memories fade.