No bill is better than a bad bill

the politics of a bad bill are worse than no bill. being forced to buy junk insurance will turn the people against the Dems more than anything I can think of.

Oddly, the hopey changey brigade have brought me to a higher level of cynicism than I've ever had (and my political consciousness was shaped during the Contract with America, more on that later). Normally I'd disagree with the no bil argument when it comes to health care, but I do see this crop of opportunistic peasant haters drafting a bill that will leave all but the healthiest/wealthiest worse off. Sort of an anti-Rawlsian ideal.

Thanks, progs, for turning this optimistic person into a cranky old man decades before my time.

Is history about to repeat itself? I am most interested by Ted Kennedy's actions in this: [my emphasis]

So here's a question that few have asked, and that virtually no one knows the answer to: How important is conference committee to the way the White House is looking at health care? I've heard it's pretty important. Heard the same thing about Harry Reid, actually. If that's true, then this is what the Democratic leadership is thinking: The overriding imperative right now is to keep health reform alive. That's all that matters. Get it out of the Finance Committee. Get it off the Senate floor. If it's cut down to half a loaf, fine. You don't fix it now. You fix it in conference. Or you let Henry Waxman do it for you.

That, incidentally, is not an unprecedented strategy. It's what the Bush administration did with Medicare Part D. The expansion the Senate wrote was genuinely bipartisan: Ted Kennedy and Tom Daschle both voted for the legislation. But the version that came out of conference committee was significantly more conservative. Kennedy and Daschle abandoned the bill. Democrats began organizing against legislation they had previously supported. It passed anyway.

It passed because it's hard to filibuster bills emerging from conference. You can't change them, for one thing. No amendments are allowed. Nor is there time for debate. You vote for the bill, you vote against the bill, or you filibuster the bill. Those are your options. Democrats are likely to walk out of conference committee with 60 senators in their party. Ben Nelson will not be able to ask to change this bit he doesn't like, and Evan Bayh will not be allowed to offer an amendment weakening that piece. They stand with the White House or against it. And it is, in the estimation of most observers I've talked to, hard to imagine them literally filibustering the final vote on health reform. The White House would torture them until they lost reelection. And if no Democrats are willing to filibuster, then the White House could lose as many as 10 of them and still pass the bill.

With a Democratic president whipping, and we know Obama can whip with the best/worst of them, how many in this Congress would have the courage to abandon a bill gone bad? (Especially Representatives, who always have re-election campaigns lurking.)

I suppose there is a remote possibility that if we got a bad bill Sanders would filibuster it with the support of Conservative Republicans. We could have a truly weird filibuster.

WSJ editorial on Romneycare and "Obamacare":

For 15 years Massachusetts has also imposed mandates known as guaranteed issue and community rating -- meaning that insurers must cover anyone who applies, regardless of health or pre-existing conditions, and also charge everyone the same premium (or close to it). Yet these mandates allow people to wait until they're sick, or just before they're about to incur major medical expenses, to buy insurance. This drives up costs for everyone else, which helps explain why small-group coverage in Massachusetts is so much more expensive than in most of the country. Mr. Romney argued -- as Democrats are arguing now -- that the individual mandate would make that problem disappear, since everyone is always supposed to be covered.

Well, the returns are rolling in, and a useful case study comes from the community-based health plan Harvard-Pilgrim. CEO Charlie Baker reports that his company has seen an "astonishing" uptick in people buying coverage for a few months at a time, running up high medical bills, and then dumping the policy after treatment is completed and paid for. Harvard-Pilgrim estimates that between April 2008 and March 2009, about 40% of its new enrollees stayed with it for fewer than five months and on average incurred about $2,400 per person in monthly medical expenses. That's about 600% higher than Harvard-Pilgrim would have otherwise expected.

The individual mandate penalty for not having coverage is only about $900, so people seem to be gaming the Massachusetts system. "This is a problem," Mr. Baker writes on his blog, in the understatement of the year. "It is raising the prices paid by individuals and small businesses who are doing the right thing by purchasing twelve months of health insurance, and it's turning the whole notion of shared responsibility on its ear."

This being the WSJ editorial pages, their solution is that the mandate should be removed (and community rating abolished, perhaps?).

Mr. Baker is right, though he underestimates the extent to which it is rational for people to do this, considering the government-mandated incentives. To one degree or another all insurance pools require the younger and healthier to subsidize the older and sicker, though part of the risk-sharing bargain is the hedge against unanticipated or future health problems -- i.e., true insurance. The combination of guaranteed issue and community rating actively encourages parts of the healthier population to forgo coverage and thus blow up voluntary risk pools. No doubt our politicians will conclude that the solution is to raise the penalty for going uninsured, though it would be easier and more rational to let insurance markets function without mandates.

Single-payer solves this problem by covering everyone automatically and also charging everyone automatically. I could phrase this in a less attractive way by saying that it removes the element of choice from the question of whether to have and pay for health insurance. "Choice" has become such an automatic element of the discussion of health care reform that I am very much afraid that this is how it would be phrased.

This is why I think it is very important how we talk about these things, as I've said before here and here.

Emphasize the element of choice, sure - when talking about choosing doctors, hospitals, etc. Right now I suspect most people with health insurance can't really choose which doctor they see, not if they want to have their visits covered. (Like my mom, I get a "choice" from a menu of doctors, none of whom is the woman who used to be my PCP: my health insurance plan at work was changed and she does not participate in my current HMO.)

But when we talk about coverage, we must emphasize the social justice aspect. No, I'd go farther than that: it is just purely patriotic, especially in tough economic times, that we as a society make sure that everyone is taken care of and no one slips through the cracks. I find it completely unacceptable that the HELP committee seems to think it is OK to let even 3% of us go without coverage just to push through a bill that allows the insurance companies to go on profiting from our misery. I find it completely unacceptable that their plan seems to be designed to force my son to stay with his current employer-provided plan, for which he pays a hefty part of the premium, but which has (so far) not paid for much of the care he needs.

This is America. We take care of each other. That's how it should be.

[Yes, I want to elevate this to a whole post centered around LBJ's words on Medicare, but I'm too rushed to write it at the moment.]

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P.S. the WSJ editorial ends in this rather telling paragraph: [my emphasis]

For many Democrats, none of this is really a surprise, or even important. Their Rube Goldberg rules are meant to transfer the costs of health care away from individuals and onto someone else -- private companies like Harvard-Pilgrim in the short term, and over time onto taxpayers.

Hmm. "individuals" != "taxpayers"?

"No bill is better than a bad bill"

Well Obama disagrees when comes to health care.

And agreed with it when it came to capping credit card interest rates.

But it is easy to understand when you realize he stands on whichever side pleases the big companies supporting him and doesn't actually help the average worker.

Whoops, my cynicism is showing...

I've been commenting on a post at Pal M.D.'s blog in which he reports that his patients express concerns that sound like right-wing talking points. (which may say as much about what kind of patients he has as anything)

He asks, more or less rhetorically (because he then goes on to answer it):

But what should we really fear about health care reform? The answer of course depends on your position and ideology. I of course hope that something is done about reimbursement for primary care physicians, but that's one issue of many. Leaving aside for a moment the cost containment elephant in the room, what ideologic fears might we have?

Maybe other people want to add theirs. I don't always agree with Pal M.D., but he has a pretty good blog. I'm not asking for people to pile on. It's just another place to make our concerns known to a possibly different audience.