Sunday, December 20, 2009

Deal on health bill is reached

By Shailagh Murray and Lori Montgomery
Washington Post
Sunday, December 20, 2009

Senate Democrats said Saturday that they had closed ranks in support of legislation to overhaul the nation's health-care system, ending months of internal division and clearing a path for quick Senate passage of President Obama's top domestic policy priority.

Majority Leader Harry M. Reid (D-Nev.) secured the pivotal 60th vote after acceding to the demands of Sen. Ben Nelson (D-Neb.) for tighter restrictions on insurance coverage for abortions, along with increased federal aid for his home state and breaks for favored health-care interests.

"Change is never easy, but change is what's necessary in America," Nelson said at a morning news conference, announcing his support as a snowstorm raged outside.

Speaking at the White House, Obama said it appears that a vote is certain on a bill that would provide coverage to more than 30 million uninsured Americans. "After a nearly century-long struggle, we are on the cusp of making health-care reform a reality," said Obama, who had dispatched senior administration officials to help lock down Nelson's support.

Republicans excoriated the bill as a threat to Medicare -- cuts to the program for the elderly would offset much of the cost -- and to the employer-based insurance system, which provides health coverage to most Americans.

"This bill is a monstrosity," said Minority Leader Mitch McConnell (R-Ky.). "This is not renaming the post office. Make no mistake -- this bill will reshape our nation and our lives."

GOP leaders, who have vowed to use every available tactic to keep the measure from advancing, invoked a rarely used Senate rule to require that the entire 383-page package of amendments introduced by Reid Saturday morning be read aloud on the floor, a process that consumed about seven hours.

But Republicans were running out of options in their quest to derail the overhaul. Securing Nelson's support allows Reid to maneuver the legislation through a complex parliamentary minefield without obstruction. A bloc of 60 votes is the exact number required to choke off the filibuster, the Senate minority's primary source of power, and the GOP's best hope of defeating the bill.

Unless the GOP yields and the vote comes sooner, the bill is expected to pass in a final Senate vote at 7 p.m. on Christmas Eve. Negotiations to merge the bill with the House version would begin early next month.

Many liberals, however, were bitterly disappointed with the bargains Reid struck to win support from moderates in his caucus, any member of which could demand alterations in exchange for his or her support.

Democratic leaders dropped a government insurance option and the idea of expanding Medicare to younger Americans. Reid also omitted language that would have eliminated the federal antitrust exemption for health insurers -- another nonstarter for Nelson
(Editor's emphasis).

Savings forecast

Congressional budget analysts reported Saturday that the revised package would not worsen the nation's fiscal situation, as GOP critics have warned. The analysts said the updated Senate bill would spend $871 billion over the next decade to extend coverage to the uninsured by dramatically expanding Medicaid and by offering federal subsidies to those who lack affordable coverage through employers.

Editor's NOTE:

As always, the "devil will be in the details." Without a public option or some other powerful incentive which forces the health insurance industry to stop excessive rate increases, there will be no way to control costs or to make certain that people will be able to afford the private coverage which is mandated. Moreover, the industry has four years in which to continue the despicable practice of refusing to cover adult patients with pre-existing medical conditions. Even in 2014 there is no guarantee that premiums for those with pre-existing conditions will be affordable. Worse yet, the purported increased medicaid coverage the bill envisions is the very worst of all reimbursement schemes available for medical providers. The fact that medicare reimbursements will be decreased rather than increased is also self-defeating as medicare reimbursements are already too low.

The current iteration of the Senate bill does nothing to eliminate the wasted dollars which the private insurance industry now spends on excessive corporate salaries/bonuses/benefits or the dollars which accrue to stockholders of publicly traded health insurance companies. Those proceeds should be payed to providers of actual health care.

It remains unclear how the Senate and House bills which differ so markedly can be reconciled in conference. It appears that the health insurance and pharmaceutical industries have managed through extensive lobbying efforts to secure their morally illicit monopolies.

--Dr. J. P. Hubert