Thursday, December 24, 2009

60 Makes a Bill + Pushing from the Left

Delivered, but not sealed or signed--yet, and the US Senate's version of the historic yet problematic health care "reform" bill, that is. With 58 Democratic votes and the those of the two independents who caucus with them, the Democrats passed the severely gutted, lobbyist-shaped, and insurance industry-and-Big Pharma-friendly health care "reform" legislation. Now it heads to conference, where some contentious issues must be ironed out before it can be revoted up by both houses and then sent to President Barack Obama to be signed into law. Despite his aloofness from the turbulent Congressional debates, he's said he'll now get involved. I'll believe it when he does it.

Senate Democrats
Senate Democratic leaders announcing the passage of the legislation

The Senate bill
  • has no government-run health insurance (i.e. public) option.
  • has no Medicare buy-in for people under the current age of eligibility. (A recent Quinnipiac polled showed 56-38% support for the public option and 64-30% support for Medicare expansion.)
  • still includes the very mandate that President Obama campaigned against, and does not "cover" 30 million new people, but forces them to buy insurance under penalty of fine.
  • has weaker subsidies than those in the House bill.
  • includes a problematic excise tax.
  • does not include safe drug reimportation, though the president campaigned on this.
  • bars undocumented immigrants from buying insurance on the available exchanges, out of racism and spite.
  • includes anti-abortion provisions.
  • does not cover all Americans citizens.
  • does not really kick in for 4 years, by which time the GOP could repeal most of it or even the whole thing.
  • did not emerge from the "transparent," televised (on CSPAN) negotations the president promised, and instead has lobbyists' wishes and demands all over it, making it, sad to say, liable to critiques and attacks from the right-wing, who offered no substantive reform proposals of their own.
Most problematically, it not only doesn't dramatically "bend" the cost curve, but it fails to ensure 1) affordable insurance for ALL Americans, and 2) cut the excessive US spending on health care, which results of from industry profits, waste and inefficiency, a fee-for-treatment approach, and many other sources.

In case anyone has forgotten the USA health care costs per person exceed other industrialized countries by a wide margin.
Total health care spending per person, in 2007:
USA: $7290
Switzerland: $4417
France: $3601
United Kingdom: $2992
Average of OECD developed nations: $2964
Italy: $2686
Japan: $2581

In part this results from our reliance on a for-profit health care system, and despite his campaign promises, the President is doing little to change this. The huge disparity in costs is one of the main reasons progressives--labeled as "insane," the "Internet left fringe," "the left of the left," "on hallucinogens," etc.--by the President's spokespeople and media commentators and pundits--were pushing for either a universal single-payer program or a robust public health insurance option. This cost disparity, and the rising cost curve, are unsustainable without serious damage to the US economy and Americans' well-being.

The Senate's bill does include some worthwhile measures. It does bar the denial of health care based on pre-existing conditions, for children and for adults. It pushes Pharma to cover the doughnut hole. It includes funding for community health centers, which could provide more comprehensive and preventive health care services. It will allow more people--single adults--to buy into the Medicaid program. It also extends funding for Medicaid and Medicare, while streamlining the latter. In the event of a catastrophic illness it provides federal reinsurance to private companies that provide insurance for their employees. It funds training and education programs for non-physician healthcare professionals. So it's not totally worthless. But in terms of providing universal, affordable, high-quality care, and, to use the neoliberals' favorite concept, "choice," it falls--from what I can tell, FAR--short.

Nevertheless, one of the most credible critics of the legislation and the process by which it wound its way from rhetoric to near-law, New York Times columnist Paul Krugman, argues in its favor. As he writes:

And for all its flaws and limitations, it’s a great achievement. It will provide real, concrete help to tens of millions of Americans and greater security to everyone. And it establishes the principle — even if it falls somewhat short in practice — that all Americans are entitled to essential health care.

Many people deserve credit for this moment. What really made it possible was the remarkable emergence of universal health care as a core principle during the Democratic primaries of 2007-2008 — an emergence that, in turn, owed a lot to progressive activism. (For what it’s worth, the reform that’s being passed is closer to Hillary Clinton’s plan than to President Obama’s). This made health reform a must-win for the next president. And it’s actually happening.

So progressives shouldn’t stop complaining, but they should congratulate themselves on what is, in the end, a big win for them — and for America.
Jonathan Chait, after a revisionist account of the 2000 election, agrees. So I guess it's a go--but also a strong reminder that for better legislation in the future, progressives will have to be relentless and, when necessary, willing to let the President and Congress know they do not have us in the pocket. No matter what Rahm Emanuel says.


One of my Twigente, Keraflo, posted this link to Cenk Uygur's Huffington Post article on moving President Obama (and the Congress) to the left. I agree with everything he's saying. Silence abets the status quo, which is what the majority opposed last year. Yet if we uncritically support the Obama administartion, criticizing only its right-wing opponents while not calling the president and the Congress when they fall far short of "change we can believe it" and not grow cynical, which strengthens those already in power.


Yoweri MuseveniRod 2.0 has been up on the grave situation facing LGBTQ people in Uganda, where a viciously homophobic Anti-Homosexuality Bill is making its way through that country's parliament. In his most recent post on the subject, he notes that Uganda's president, Yoweri Museveni (at right,, has decided not to intervene directly to stop legislation that would harshly penalize people suspected of being LGBTQ, despite having given assurances that he would do so to US authorities. Museveni is now saying he will try to convince his party, which has a parliamentary majority, not to support it. The original legislative proposals went so far as proposing capital penalties--death--for LGBTQ acts. In this post, Rod links to an article suggesting that the opposition party, the Uganda Peoples Congress (UPC), will oppose the legislation. This is unlikely to stop the bill's passage, but will register that it, and the toxic homophobia promoted by senior figures in Uganda's government, do not have tacit, universal support.

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