Thursday, December 24, 2009

Senate Passes Historic Health Bill

Updated: 12/24/09 8:34 AM EST

After months of blown deadlines and political near-death experiences, a sweeping health care reform bill cleared the Senate Thursday on a party-line vote, putting President Barack Obama within reach of a domestic policy achievement that has eluded Democrats for decades.

With Vice President Joe Biden presiding over the session, Democrats gathered in the chamber before sunrise on the day before Christmas to cast a vote long in coming but in the end, hardly a surprise, a 60-39 tally that was the fourth time in as many days that Democrats proved they could muster the winning margin.

But this was the one that counted, the bookend to a House vote last month that puts Congress on record saying that Americans have the right to affordable health insurance, with plans that will cover 30 million Americans currently without it.

Senate Majority Leader Harry Reid (D-Nev.) said before the vote that Americans could wait no longer. “We certainly don’t have. . .the luxury of waiting. We may not completely cure this crisis today or tomorrow, but we must strive toward that progress.”

When Sen. Robert Byrd’s name was called, the ailing West Virginian said, “Mr. President, this is for my friend, Ted Kennedy – aye," a reference to the late Massachusetts senator who long fought for universal health care.

But Senate Republican leader Mitch McConnell (R-Ky.) vowed: “This fight isn’t over. My colleagues and I will work to stop this bill from becoming law. That’s the clear will of the American people — and we’re going to continue to fight on their behalf.”

The vote sets the stage for difficult House-Senate negotiations during which Democrats will be forced to settle differences that have lingered for months, and there is no guarantee a bill will pass in the end.

Sen. Joe Lieberman (I-Conn.), one of the last Democratic holdouts, once again made clear that his vote isn’t assured when the bill returns to the Senate. In the hallway outside the vote, he told his fellow moderate, Sen. Ben Nelson (D-Neb.), “Our work is not over.”

"Splitting the difference here could well break the 60 vote consensus," Lieberman said to reporters.

With momentum at their back, Democrats believe they can craft a compromise that, in broad strokes, would expand coverage through subsidies to help Americans buy insurance and allowing more people into the Medicaid program. The Senate plan includes a new national health insurance program overseen by the government but offered through private insurers.

It would prevent insurance companies from dropping patients who get sick and create a new legal requirement that all Americans must own health insurance – a provision already under growing attack from conservatives.


As always, the "devil will be in the details." It is difficult to conceive of how the House and Senate bills can be reconciled given that they are so different. Recall, the House bill contains a moderately aggressive "Public Option" while the Senate bill does not contain any Public Option at all.

Moreover the Senate bill has minimal provisions for cost containment. The most remarkable fact is that the Senate bill will force Americans to buy private health care coverage for the first time as a matter of law without providing any tough sanctions to prevent health insurance companies from excessively raising rates. After the Public Option was defeated in the Senate, health insurance company stocks soared in value indicating that the Senate bill is a financial bonanza for the private health insurance industry--a moral travesty that.

--Dr. J. P. Hubert

Sunday, December 20, 2009

Health-care bill wouldn't bring real reform

By Howard Dean
Washington Post
Thursday, December 17, 2009

If I were a senator, I would not vote for the current health-care bill. Any measure that expands private insurers' monopoly over health care and transfers millions of taxpayer dollars to private corporations is not real health-care reform. Real reform would insert competition into insurance markets, force insurers to cut unnecessary administrative expenses and spend health-care dollars caring for people. Real reform would significantly lower costs, improve the delivery of health care and give all Americans a meaningful choice of coverage. The current Senate bill accomplishes none of these.

Real health-care reform is supposed to eliminate discrimination based on preexisting conditions. But the legislation allows insurance companies to charge older Americans up to three times as much as younger Americans, pricing them out of coverage. The bill was supposed to give Americans choices about what kind of system they wanted to enroll in. Instead, it fines Americans if they do not sign up with an insurance company, which may take up to 30 percent of your premium dollars and spend it on CEO salaries -- in the range of $20 million a year -- and on return on equity for the company's shareholders. Few Americans will see any benefit until 2014, by which time premiums are likely to have doubled. In short, the winners in this bill are insurance companies; the American taxpayer is about to be fleeced with a bailout in a situation that dwarfs even what happened at AIG.

From the very beginning of this debate, progressives have argued that a public option or a Medicare buy-in would restore competition and hold the private health insurance industry accountable. Progressives understood that a public plan would give Americans real choices about what kind of system they wanted to be in and how they wanted to spend their money. Yet Washington has decided, once again, that the American people cannot be trusted to choose for themselves. Your money goes to insurers, whether or not you want it to.

To be clear, I'm not giving up on health-care reform. The legislation does have some good points, such as expanding Medicaid and permanently increasing the federal government's contribution to it. It invests critical dollars in public health, wellness and prevention programs; extends the life of the Medicare trust fund; and allows young Americans to stay on their parents' health-care plans until they turn 27. Small businesses struggling with rising health-care costs will receive a tax credit, and primary-care physicians will see increases in their Medicare and Medicaid reimbursement rates.

Improvements can still be made in the Senate, and I hope that Senate Democrats will work on this bill as it moves to conference. If lawmakers are interested in ensuring that government affordability credits are spent on health-care benefits rather than insurers' salaries, they need to require state-based exchanges, which act as prudent purchasers and select only the most efficient insurers. Sen. John Kerry (D-Mass.) offered this amendment during the Finance Committee markup, and Democrats should include it in the final legislation. A stripped-down version of the current bill that included these provisions would be worth passing.

In Washington, when major bills near final passage, an inside-the-Beltway mentality takes hold. Any bill becomes a victory. Clear thinking is thrown out the window for political calculus. In the heat of battle, decisions are being made that set an irreversible course for how future health reform is done. The result is legislation that has been crafted to get votes, not to reform health care.

I have worked for health-care reform all my political life. In my home state of Vermont, we have accomplished universal health care for children younger than 18 and real insurance reform -- which not only bans discrimination against preexisting conditions but also prevents insurers from charging outrageous sums for policies as a way of keeping out high-risk people. I know health reform when I see it, and there isn't much left in the Senate bill. I reluctantly conclude that, as it stands, this bill would do more harm than good to the future of America.

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