Monday, November 09, 2009

Reform... Or Not

***Updated to include links to the interviews. Click the links to hear Howie Klein and John Nichols***

I'm truly conflicted.

I watched much of the "debate" in the House of Representatives on Saturday. I watched some during the early morning hours, presided over by John Dingell - who's spent his entire 28 terms in Congress, and carried on the legacy his father, John Dingell, Sr. started when he first introduced health care legislation in 1943 -- when the Republicans attempted to derail the debate by objecting every time a Democrat spoke.

But it eventually got back on track, and the bill - HR 3962 - Affordable Health Care for America Act, squeaked through by a vote of 220-215.

There's a lot of good in the bill, but way too much bad. Most notably, the horrendous Stupak Amendment, which was introduced and passed in the eleventh hour, which sets women's reproductive rights back to the stone age.

Tonight, John Nichols from The Nation will join me to talk about his piece "Six Smart Progressive Complaints About House Health Bill", and I agree with all of those arguments.

Congressmen Dennis Kucinich (D-OH) and Eric Massa (D-NY) both voted against the bill for reasons that we should all heed.


"We have been led to believe that we must make our health care choices only within the current structure of a predatory, for-profit insurance system which makes money not providing health care. We cannot fault the insurance companies for being what they are. But we can fault legislation in which the government incentivizes the perpetuation, indeed the strengthening, of the for-profit health insurance industry, the very source of the problem. When health insurance companies deny care or raise premiums, co-pays and deductibles they are simply trying to make a profit. That is our system.

"Clearly, the insurance companies are the problem, not the solution. They are driving up the cost of health care. Because their massive bureaucracy avoids paying bills so effectively, they force hospitals and doctors to hire their own bureaucracy to fight the insurance companies to avoid getting stuck with an unfair share of the bills. The result is that since 1970, the number of physicians has increased by less than 200% while the number of administrators has increased by 3000%. It is no wonder that 31 cents of every health care dollar goes to administrative costs, not toward providing care. Even those with insurance are at risk. The single biggest cause of bankruptcies in the U.S. is health insurance policies that do not cover you when you get sick.

"But instead of working toward the elimination of for-profit insurance, H.R. 3962 would put the government in the role of accelerating the privatization of health care. In H.R. 3962, the government is requiring at least 21 million Americans to buy private health insurance from the very industry that causes costs to be so high, which will result in at least $70 billion in new annual revenue, much of which is coming from taxpayers. This inevitably will lead to even more costs, more subsidies, and higher profits for insurance companies-- a bailout under a blue cross.

"By incurring only a new requirement to cover pre-existing conditions, a weakened public option, and a few other important but limited concessions, the health insurance companies are getting quite a deal. The Center for American Progress' blog, Think Progress, states, 'since the President signaled that he is backing away from the public option, health insurance stocks have been on the rise.' Similarly, health care stocks rallied when Senator Max Baucus introduced a bill without a public option. Bloomberg reports that Curtis Lane, a prominent health industry investor, predicted a few weeks ago that 'money will start flowing in again' to health insurance stocks after passage of the legislation. last month reported that pharmacy benefit managers share prices are hitting all-time highs, with the only industry worry that the Administration would reverse its decision not to negotiate Medicare Part D drug prices, leaving in place a Bush Administration policy.

"During the debate, when the interests of insurance companies would have been effectively challenged, that challenge was turned back. The 'robust public option' which would have offered a modicum of competition to a monopolistic industry was whittled down from an initial potential enrollment of 129 million Americans to 6 million. An amendment which would have protected the rights of states to pursue single-payer health care was stripped from the bill at the request of the Administration. Looking ahead, we cringe at the prospect of even greater favors for insurance companies.

"Recent rises in unemployment indicate a widening separation between the finance economy and the real economy. The finance economy considers the health of Wall Street, rising corporate profits, and banks' hoarding of cash, much of it from taxpayers, as sign of an economic recovery. However in the real economy-- in which most Americans live - the recession is not over. Rising unemployment, business failures, bankruptcies and foreclosures are still hammering Main Street.

"This health care bill continues the redistribution of wealth to Wall Street at the expense of America's manufacturing and service economies which suffer from costs other countries do not have to bear, especially the cost of health care. America continues to stand out among all industrialized nations for its privatized health care system. As a result, we are less competitive in steel, automotive, aerospace and shipping while other countries subsidize their exports in these areas through socializing the cost of health care.

"Notwithstanding the fate of H.R. 3962, America will someday come to recognize the broad social and economic benefits of a not-for-profit, single-payer health care system, which is good for the American people and good for America's businesses, with of course the notable exceptions being insurance and pharmaceuticals."
From Eric Massa's office:
Today Congressman Eric Massa outlined his reasons for voting against H.R. 3962 on Saturday night. To summarize the specific votes: Rep. Massa voted for the rule of debate, against the Stupak Amendment and against final passage of the bill.

When H.R. 3962 was first introduced on Thursday, October 29th, Rep. Massa canceled his weekend schedule to read and review the legislation. Following seven days of studying the bill, consulting with experts and speaking with constituents, Rep. Massa announced his intention to vote against the bill.

Rep. Massa had several concerns because the legislation did not meet several of his key objectives, including guaranteed universal access for all Americans and an assurance of individual affordability. While this bill does contain a public option, it is far from a "robust" one and Rep. Massa pledged, in a letter months ago, to vote against anything less than that. The public option in this bill is available for only about 2% of the American population and its premium rates will match private health insurance, guaranteeing no effective competition in the marketplace.

Additionally, he thinks that this bill, if signed into law, will not do enough to regulate the private for-profit health insurance industry and will actually empower them further. This is a major problem with the legislation as far as he is concerned. During the months of public debate on this topic, Rep. Massa called for the health insurance industry to be able to write plans across state lines and, while this bill partially addresses this, it does not lift this exemption outright. As such, he views this as a half measure rather than true interstate competition and believes that the goals of interstate competition will not be realized.

Rep. Massa also expressed concerns about the constitutionality of the individual mandate. While the Constitution empowers the Congress to raise and levy taxes, there is no clear indication that it allows for Congress to require the public to purchase insurance plans if they can afford them.

Detailed careful reading and understanding of the bill shows that should this become law, property taxes in New York State must increase by a minimum of 3%. By increasing Medicaid availability to citizens with an income of 150% of the federal poverty level, the federal government passes to New York State and its counties a cost sharing increase of at least 3% at the county level. Rep. Massa views this as being exceptionally counterproductive to our economy at this time.

During the closing hours of the debate, Rep. Massa voted against the Stupak Amendment which he viewed as a significant universal increase of current federal law. For the first time, if passed, the federal government would have prohibited a private citizen from using private funding to buy an insurance policy that covered elements of reproductive rights. The bill as written is clear, no federal funding for abortion procedures is allowed. Rep. Massa agrees with that but does not support an increase in federal law on this matter. This amendment passed and became part of the final legislation.

While there are several provisions that he did like in the bill, such as the elimination of patient rejections on the basis of pre-existing conditions, and the closing of the Medicare Part D Donut hole, members of Congress cannot vote for one part of a bill and against another.

"There are several reasons why I voted 'no' on H.R. 3962," said Congressman Eric Massa. "I have always said that I will vote 'no' on a bad bill to try and get a better one and that's what I did. Reforming our health care system is critical to our economy and our nation, but I had some serious concerns regarding the bill that we voted on Saturday night. If the Senate is able to move forward, I hope we can get a better bill back for a conference version."
I love that these two men are standing firm on their principles. Some progressives have very short memories. We cheered the Congressional Progressive Caucus when 62 of them sent a letter to Speaker Pelosi in which they vowed to vote against any bill that did not contain a "robust" public option. Kucinich and Massa are the last men standing.

And the despicable Stupid, er, Stupak Amendment just made this bill reprehensible. So, how could anyone who cares about women's rights vote for this bill with that amendment in it? To move it forward. This is NOT the final bill.

From the NY Times:
Some Democrats said they voted for the legislation so they could seek improvements in it. “This bill will get better in the Senate,” said Representative Jim Cooper, a Tennessee Democrat who has been outspoken in his criticism of some provisions of the bill but decided to support it. “If we kill it here, it won’t have a chance to get better.”
We can only hope!

Is there enough good in this bill, as it stands today, to outweigh the bad? I honestly don't know. But I can support these measures that ARE included:
  • Ending the insurance companies' anti-trust exemption
  • Extending coverage for kids to remain on their parents plans up to their 27th birthday
  • Creating a new voluntary, public long term insurance program
  • Begins closing the Medicare Part D Donut Hole immediately
  • Immediate help for the uninsured
I know that if we held out for what I'd consider acceptable, we'd never get anything done.

Down With Tyranny's Howie Klein will join me for the first hour tonight to break down the vote, and look at who voted for what, and consider the ramifications.

Listen live (11pm-1am ET) by clicking here, and add your thoughts by calling in at 866-303-2270.